Bossi Paolo, Ascierto Paolo A, Basset-Seguin Nicole, Dreno Brigitte, Dummer Reinhard, Hauschild Axel, Mohr Peter, Kaufmann Roland, Pellacani Giovanni, Puig Susana, Moreno-Ramírez David, Robert Caroline, Stratigos Alex, Gutzmer Ralf, Queirolo Paola, Quaglino Pietro, Peris Ketty
Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy.
Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy.
Crit Rev Oncol Hematol. 2023 Sep;189:104066. doi: 10.1016/j.critrevonc.2023.104066. Epub 2023 Jul 11.
Basal cell carcinoma (BCC), the most common type of skin cancer, is characterized by aberrant activation of the hedgehog molecular pathway. Systemic therapy is indicated when local approaches, such as surgery and radiation, are inappropriate. In this article, a group of clinical experts recommends the long-term management strategy for advanced BCC patients treated with systemic therapy. The hedgehog inhibitors sonidegib and vismodegib are first-line treatments for advanced BCC with a long-lasting response, but long-term treatment with hedgehog inhibitors is often challenged by tolerability issues. However, several strategies for adverse effect management are available, such as dose interruptions, on-label alternate-day dosing and supportive medications. In conclusion, although BCC shows a high tumor mutational burden that favors a response to immunotherapy, experts recommend keeping patients on hedgehog inhibitors limiting immunotherapy to those who developed resistance during hedgehog inhibitor therapy or in case of persisting toxicity despite long-term management of adverse events.
基底细胞癌（BCC）是最常见的皮肤癌类型，其特征是刺猬分子通路的异常激活。当手术和放疗等局部治疗方法不适用时，需进行全身治疗。在本文中，一组临床专家推荐了接受全身治疗的晚期基底细胞癌患者的长期管理策略。刺猬抑制剂索尼德吉和维莫德吉是晚期基底细胞癌的一线治疗药物，疗效持久，但长期使用刺猬抑制剂治疗常常受到耐受性问题的挑战。然而，有几种不良反应管理策略可供选择，如剂量中断、标签上的隔日给药和支持性药物。总之，尽管基底细胞癌显示出较高的肿瘤突变负荷，有利于对免疫治疗产生反应，但专家们建议让患者持续使用刺猬抑制剂，将免疫治疗仅限于那些在刺猬抑制剂治疗期间产生耐药性或尽管对不良事件进行了长期管理仍存在持续毒性的患者。
