Verkouteren Babette J A, Reyners An K L, Aarts Maureen J B, Mosterd Klara
Department of Dermatology, Maastricht University Medical Center, Maastricht, The Netherlands.
GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.
Case Rep Dermatol. 2024 Jun 27;16(1):173-180. doi: 10.1159/000539592. eCollection 2024 Jan-Dec.
Basal cell carcinoma (BCC) is treated with local surgery or noninvasive treatment modalities. If a BCC remains untreated, it can develop into a locally advanced BCC or a metastatic BCC.
Here we report in detail the management of three complex advanced BCC (aBCC) after treatment failure with vismodegib. On all tumors, next generation DNA sequencing in the Center for Personalized Cancer Treatment-02 (CPCT-02) study was performed; subsequently, patients were included in the Drug Rediscovery Protocol (DRUP) trial, in which treatment was started with commercially available targeted anticancer drugs based on the molecular tumor profile. All patients showed partial response or stable disease following treatment with second line PD-1 inhibitors with an average duration of response of 12.3 months.
DISCUSSION/CONCLUSION: Immunotherapy can be a treatment option for aBCC resistant to hedgehog pathway inhibitor treatment. However, despite the high tumor mutational burden of aBCCs, immunotherapy does not always lead to a long response. Rechallenge or combining treatment of hedgehog inhibitors and PD-1 inhibitors by parallel or alternating cycles may be a strategy to lengthen the treatment response.
基底细胞癌（BCC）采用局部手术或非侵入性治疗方式。如果BCC未得到治疗，它可能发展为局部晚期BCC或转移性BCC。
在此，我们详细报告了维莫德吉治疗失败后三例复杂晚期BCC（aBCC）的治疗情况。在个性化癌症治疗中心02（CPCT - 02）研究中，对所有肿瘤进行了二代DNA测序；随后，患者被纳入药物重新发现方案（DRUP）试验，根据分子肿瘤图谱，开始使用市售靶向抗癌药物进行治疗。所有患者在接受二线PD - 1抑制剂治疗后均显示部分缓解或病情稳定，平均缓解持续时间为12.3个月。
讨论/结论：免疫疗法可以作为对刺猬信号通路抑制剂治疗耐药的aBCC的一种治疗选择。然而，尽管aBCC的肿瘤突变负荷较高，但免疫疗法并不总是能带来长期缓解。通过平行或交替周期重新挑战或联合使用刺猬信号通路抑制剂和PD - 1抑制剂进行治疗可能是延长治疗反应的一种策略。
