Heppt Markus V, Gebhardt Christoffer, Hassel Jessica C, Alter Mareike, Gutzmer Ralf, Leiter Ulrike, Berking Carola
Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany.
Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CC ER-EMN), 91054 Erlangen, Germany.
Cancers (Basel). 2022 Sep 20;14(19):4547. doi: 10.3390/cancers14194547.
The first-line therapy for locally advanced basal cell carcinoma (laBCC) is Hedgehog pathway inhibitors (HHIs), as they achieve good efficacy and duration of response. However, toxicity in the course of long-term treatment may lead to a decrease in the quality of life, and consequently to interruption or even discontinuation of therapy. As HHI therapy is a balancing act between effectiveness, adverse events, quality of life, and adherence, numerous successful treatment strategies have evolved, such as dose reduction and dose interruptions with on-off treatment schedules or interruptions with re-challenge after progression. As a small percentage of patients show primary or acquired resistance to HHIs, the inhibition of programmed cell death protein 1 (PD-1) has been approved as a second-line therapy, which may also be accompanied by immune-related toxicities and non-response. Thus, optimization of current treatment schedules, novel agents, and combination strategies are urgently needed for laBCC. Here, we narratively model the treatment sequence for patients with laBCC and summarize the current state of approved treatment regimens and therapeutic strategies to optimize the long-term management of laBCC.
局部晚期基底细胞癌（laBCC）的一线治疗方法是使用刺猬信号通路抑制剂（HHIs），因为它们能取得良好的疗效和反应持续时间。然而，长期治疗过程中的毒性可能导致生活质量下降，进而导致治疗中断甚至停止。由于HHI治疗是在有效性、不良事件、生活质量和依从性之间的一种权衡，因此出现了许多成功的治疗策略，如剂量减少、采用开-关治疗方案的剂量中断或病情进展后重新挑战的中断治疗。由于一小部分患者对HHIs表现出原发性或获得性耐药，程序性细胞死亡蛋白1（PD-1）的抑制已被批准作为二线治疗方法，这也可能伴随着免疫相关毒性和无反应情况。因此，迫切需要优化当前的治疗方案、新型药物和联合策略来治疗laBCC。在此，我们阐述了laBCC患者的治疗顺序，并总结了已批准的治疗方案和治疗策略的现状，以优化laBCC的长期管理。
