Neoadjuvant vismodegib reduces need for surgery in periocular basal cell carcinoma

Neoadjuvant treatment with vismodegib achieves mixed clinical and histological response in periocular basal cell carcinoma (BCC) but limits the need for extensive surgery, a recent study has found. Final surgical excision improves outcomes, leading to clear margins and low recurrence rates.

Researchers conducted a retrospective case series looking at eight patients (mean age 57.6 years, five men) who had received neoadjuvant vismodegib for the management of locally advanced periocular BCC. All participants were treated until maximal response. To simulate the planned tumour excision without treatment, the maximum tumour diameter with a surrounding 3-mm margin was compared before vs after treatment.

Vismodegib was given at 150-mg, once-daily doses, and the treatment period lasted for a median of 6 months. All participants showed some clinical response, though six of eight only reached partial response. All but one experienced side effects, of which muscle cramps, hair loss, and dysgeusia (n=5 each) were most common.

After a mean of 5.4±3.7 weeks following vismodegib completion, patients underwent surgical excision of the tumour. Without the use of vismodegib, the maximum excision margin was 27.3±8.6 mm, which dropped to 19.18.5 mm after vismodegib treatment. Two patients saw a reduction of ≤3 mm in the maximum diameter.

All patients achieved clear margins. Histological examination of the excised samples showed that majority of the patients only had residual BCC, while two achieved complete regression. Over the average follow-up of 13.4±5.2 months, no cases of recurrence were detected.