Habashy Suzanne, Jafri Aliya, Osman Hiba O, Thomas Neena E, Udekwe Somtochi, Heindl Stacey E
Family Medicine/Dermatology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Biochemistry and Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Cureus. 2021 Mar 12;13(3):e13859. doi: 10.7759/cureus.13859.
Basal cell carcinoma (BCC) is the most common non-melanoma skin cancer and is on the rise. Most BCCs are benign; however, a very small percentage are locally advanced and metastatic. The pathway that normally regulates cell growth and proliferation is directed by the hedgehog pathway (HP). In BCC, it becomes over-stimulated due to genetic abnormalities. Treatments for BCC include local treatment by cryotherapy (liquid nitrogen), topical immunosuppression, surgery, or radiotherapy. Systemic treatment may be required in locally advanced lesions, metastatic BCC, or individuals who are inoperable. The systemic treatments of BCC act to inhibit the HP and are called hedgehog pathway inhibitors. The first one being vismodegib and the second sonidegib. Although these treatments have shown promising results, they have prominent side effects in almost all patients, with few patients having to discontinue the treatment. About 50% of patients did not respond to treatment from the beginning, some had partial responses, others had recurrence after discontinuing the drugs, and few had worsening of the disease. In this paper, we will explore the most common side effects, resistance, and different methods to overcome resistance to ensure the highest rate of cure for BCC.
基底细胞癌（BCC）是最常见的非黑色素瘤皮肤癌，且其发病率正在上升。大多数基底细胞癌是良性的；然而，极小比例的基底细胞癌会出现局部进展和转移。正常情况下调节细胞生长和增殖的途径由刺猬信号通路（HP）主导。在基底细胞癌中，由于基因异常，该通路会受到过度刺激。基底细胞癌的治疗方法包括冷冻疗法（液氮）局部治疗、局部免疫抑制、手术或放疗。对于局部进展性病变、转移性基底细胞癌或无法进行手术的个体，可能需要进行全身治疗。基底细胞癌的全身治疗旨在抑制刺猬信号通路，被称为刺猬信号通路抑制剂。第一种是维莫德吉，第二种是索尼德吉。尽管这些治疗已显示出有前景的结果，但几乎所有患者都会出现明显的副作用，少数患者不得不停止治疗。约50%的患者从一开始就对治疗无反应，一些患者有部分反应，另一些患者在停药后复发，还有少数患者病情恶化。在本文中，我们将探讨最常见的副作用、耐药性以及克服耐药性的不同方法，以确保基底细胞癌的治愈率最高。
