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Verkouteren BJA, Sinx KAE, Reinders MGHC, Aarts MJB, Mosterd K. Update on Hedgehog Pathway Inhibitor Therapy for Patients with Basal Cell Naevus Syndrome or High-frequency Basal Cell Carcinoma. Acta Derm Venereol 2022; 102:980. [PMID: 35535645 PMCID: PMC9631257 DOI: 10.2340/actadv.v102.980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
Abstract
Some patients with basal cell carcinoma develop a large number of basal cell carcinomas during their lives. The most common underlying genetic disease that causes multiple basal cell carcinomas is basal cell naevus syndrome. Basal cell naevus syndrome is caused by a germline mutation in patched-1 (PTCH1), a tumour suppressor gene of the hedgehog signalling pathway. However, in a significant portion of patients with multiple basal cell carcinomas, no underlying genetic cause is found. Nevertheless, these patients can experience a treatment burden comparable to that of patients with basal cell naevus syndrome. They are referred to as high-frequency basal cell carcinoma patients. Hedgehog pathway inhibitors were the first group of targeted therapy for basal cell carcinomas. This study reviews the literature on hedgehog pathway inhibitor therapy for patients with basal cell naevus syndrome and high-frequency basal cell carcinoma, to provide an overview on efficacy, safety, dosing regimens, tumour resistance and reoccurrence, and health-related quality of life.
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Affiliation(s)
- Babette J A Verkouteren
- Department of Dermatology, Maastricht University Medical Center+, P. Debyelaan 25, NL-6229 HX Maastricht, The Netherlands.
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Doan HQ, Chen L, Nawas Z, Lee HH, Silapunt S, Migden M. Switching Hedgehog inhibitors and other strategies to address resistance when treating advanced basal cell carcinoma. Oncotarget 2021; 12:2089-2100. [PMID: 34611482 PMCID: PMC8487719 DOI: 10.18632/oncotarget.28080] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/28/2021] [Indexed: 11/25/2022] Open
Abstract
Although basal cell carcinoma (BCC) is often managed successfully with surgery, patients with locally advanced BCC (laBCC) or metastatic BCC (mBCC) who are not candidates for surgery or radiotherapy have limited treatment options. Most BCCs result from aberrant Hedgehog pathway activation in keratinocyte tumor cells, caused by sporadic or inherited mutations. Mutations in the patched homologue 1 gene that remove its inhibitory regulation of Smoothened homologue (SMO) or mutations in SMO that make it constitutively active, lead to Hedgehog pathway dysregulation and downstream activation of GLI1/2 transcription factors, promoting cell differentiation and proliferation. Hedgehog inhibitors (HHIs) block overactive signaling of this pathway by inhibiting SMO and are currently the only approved treatments for advanced BCC. Two small-molecule SMO inhibitors, vismodegib and sonidegib, have shown efficacy and safety in clinical trials of advanced BCC patients. Although these agents are effective and tolerable for many patients, HHI resistance occurs in some patients. Mechanisms of resistance include mutations in SMO, noncanonical cell identity switching leading to tumor cell resistance, and non-canonical pathway crosstalk causing Hedgehog pathway activation. Approaches to managing HHI resistance include switching HHIs, HHI and radiotherapy combination therapy, photodynamic therapy, and targeting Hedgehog pathway downstream effectors. Increasing understanding of the control of downstream effectors has identified new therapy targets and potential agents for evaluation in BCC. Identification of biomarkers of resistance or response is needed to optimize HHI use in patients with advanced BCC. This review examines HHI resistance, its underlying mechanisms, and methods of management for patients with advanced BCC.
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Affiliation(s)
- Hung Q Doan
- Department of Dermatology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Dermatology, University of Texas McGovern Medical School, Houston, TX, USA
| | - Leon Chen
- US Dermatology Partners, Houston, TX, USA
| | - Zeena Nawas
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
| | - Heng-Huan Lee
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sirunya Silapunt
- Department of Dermatology, University of Texas McGovern Medical School, Houston, TX, USA
| | - Michael Migden
- Department of Dermatology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Dermatology, University of Texas McGovern Medical School, Houston, TX, USA.,Departments of Dermatology and Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Mir-Bonafé J, Saceda-Corralo D, Vañó-Galván S. Adverse Hair Reactions to New Targeted Therapies for Cancer. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Mir-Bonafé J, Saceda-Corralo D, Vañó-Galván S. Reacciones capilares de las nuevas terapias diana dirigidas contra el cáncer. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:182-192. [DOI: 10.1016/j.ad.2018.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 09/27/2018] [Accepted: 10/13/2018] [Indexed: 12/16/2022] Open
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Soura E, Plaka M, Dessinioti C, Chasapi V, Stefanaki C, Antoniou C, Stratigos A. Use of vismodegib for the treatment of multiple basal cell carcinomas in a patient with xeroderma pigmentosum. Pediatr Dermatol 2018; 35:e334-e336. [PMID: 30178564 DOI: 10.1111/pde.13610] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A female patient with xeroderma pigmentosum and multiple basal cell carcinomas was treated with a hedgehog pathway inhibitor (vismodegib), which successfully treated the majority of her basal cell carcinomas while preventing the appearance of new lesions. The sum diameter of lesions showed a 61% decrease after 16.5 months of treatment, although after 18.5 months of treatment, a persistent lesion showed progression and metatypical characteristics; adverse events included persistent alopecia muscle cramps, dysgeusia, and amenorrhea. Despite these limitations, vismodegib may have a role in the treatment of some patients with xeroderma pigmentosum.
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Affiliation(s)
- Efthymia Soura
- 1st University Department of Dermatology - Venereology, "Andreas Sygros" Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Michaela Plaka
- 1st University Department of Dermatology - Venereology, "Andreas Sygros" Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Clio Dessinioti
- 1st University Department of Dermatology - Venereology, "Andreas Sygros" Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Vassiliki Chasapi
- State Clinic of Dermatology - Venereology, Andreas Sygros Hospital, Athens, Greece
| | - Christina Stefanaki
- 1st University Department of Dermatology - Venereology, "Andreas Sygros" Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Christina Antoniou
- 1st University Department of Dermatology - Venereology, "Andreas Sygros" Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Alexander Stratigos
- 1st University Department of Dermatology - Venereology, "Andreas Sygros" Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
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Dessinioti C, Antoniou C, Stratigos AJ. From basal cell carcinoma morphogenesis to the alopecia induced by hedgehog inhibitors: connecting the dots. Br J Dermatol 2017. [PMID: 28626889 DOI: 10.1111/bjd.15738] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The deciphering of the hedgehog (Hh) signalling pathway implicated in the tumorigenesis of basal cell carcinoma (BCC) led to the development of targeted drug therapies, the Hh pathway inhibitors (HPIs) vismodegib and sonidegib. In the skin, physiological Hh signalling is activated in growing hair follicles (HFs), where it is required for proliferation of the epithelium of HFs during morphogenesis and for their postnatal growth. The effects of HPI treatment leading to the regression of BCC and the development of alopecia underpin the central role of the Hh pathway in BCC formation, as well as hair cycling. Given the fact that BCC is a follicular-driven tumour, it is a fine tuning of events that regulate hair cycling that may drive towards the formation of benign follicular hamartomas or malignant BCC neoplasms. Wnt/β-catenin signalling interacts with the Hh signalling during HF morphogenesis, normal hair cycling and BCC development. The aim of this review is to present how key molecular events implicated in Hh pathway crosstalk in the HF are also involved in BCC pathogenesis and result in the alopecia developed by HPI treatment.
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Affiliation(s)
- C Dessinioti
- Dermato-Oncology Unit, First Department of Dermatology, University of Athens, Andreas Syggros Hospital, Athens, Greece
| | - C Antoniou
- Dermato-Oncology Unit, First Department of Dermatology, University of Athens, Andreas Syggros Hospital, Athens, Greece
| | - A J Stratigos
- Dermato-Oncology Unit, First Department of Dermatology, University of Athens, Andreas Syggros Hospital, Athens, Greece
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