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Modulation of Hedgehog Signaling for the Treatment of Basal Cell Carcinoma and the Development of Preclinical Models. Biomedicines 2022; 10:biomedicines10102376. [PMID: 36289637 PMCID: PMC9598418 DOI: 10.3390/biomedicines10102376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/17/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
Basal Cell Carcinoma (BCC) is the most commonly diagnosed cancer worldwide. While the survivability of BCC is high, many patients are excluded from clinically available treatments due to health risks or personal choice. Further, patients with advanced or metastatic disease have severely limited treatment options. The dysregulation of the Hedgehog (Hh) signaling cascade drives onset and progression of BCC. As such, the modulation of this pathway has driven advancements in BCC research. In this review, we focus firstly on inhibitors that target the Hh pathway as chemotherapeutics against BCC. Two therapies targeting Hh signaling have been made clinically available for BCC patients, but these treatments suffer from limited initial efficacy and a high rate of chemoresistant tumor recurrence. Herein, we describe more recent developments of chemical scaffolds that have been designed to hopefully improve upon the available therapeutics. We secondly discuss the history and recent efforts involving modulation of the Hh genome as a method of producing in vivo models of BCC for preclinical research. While there are many advancements left to be made towards improving patient outcomes with BCC, it is clear that targeting the Hh pathway will remain at the forefront of research efforts in designing more effective chemotherapeutics as well as relevant preclinical models.
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Gompertz-Mattar M, Perales J, Sahu A, Mondaca S, Gonzalez S, Uribe P, Navarrete-Dechent C. Differential expression of programmed cell death ligand 1 (PD-L1) and inflammatory cells in basal cell carcinoma subtypes. Arch Dermatol Res 2021; 314:777-786. [PMID: 34647186 DOI: 10.1007/s00403-021-02289-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/21/2021] [Accepted: 10/01/2021] [Indexed: 01/14/2023]
Abstract
Few studies have evaluated programmed cell death ligand (PD-L1) expression and lymphocytic infiltrates in Basal Cell Carcinoma (BCC). The objectives of this study are to assess PD-L1 expression and markers of local immune response in nodular, superficial, and morpheaform BCC, and compare it to normal, sun-exposed skin from the periphery of intradermal nevi. This was a retrospective study that included three histological subtypes of BCCs, and sun-exposed skin from the periphery of dermal nevi as quality controls. Tissue microarrays (TMA) were constructed with subsequent staining of H&E and immunohistochemistry (IHC) for CD4, CD8, FOXP3 and PD-L1. Non-automated quantification of the infiltrate in the intratumoral and stromal compartments on TMAs was performed. A total of 115 BCC (39 nodular, 39 morpheaform, and 37 superficial) and 41 sun-exposed skin samples were included (mean age 65.4 years; 52.6% females). BCC showed higher expression of PD-L1 (5.4 vs 0.7%, p < 0.001), CD8 (29.8 vs 19.7%, p = 0.002), and FOXP3 (0.3 vs 0.06%, p = 0.022) compared to sun-exposed skin. There was a higher PD-L1 expression in nodular BCC compared with other subtypes. Low-risk BCC subtypes (superficial and nodular) exhibited more PD-L1 expression in intratumoral and stromal immune infiltrates as compared to high-risk BCC subtypes. As a limitation, no immune cells function was evaluated in this study, only the presence/absence of T-lymphocyte sub-populations was recorded. Substantial differences in both PD-L1 expression and lymphocytic infiltrates were found amongst the histological subtypes of BCC and sun-exposed skin. Highest PD-L1 expression was found in nodular BCCs which suggests a potentially targetable strategy in the treatment of this most common BCC subtype.
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Affiliation(s)
- Matias Gompertz-Mattar
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Diagonal Paraguay 362, 6th Floor, 8330077, Santiago, Chile
| | - Juan Perales
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Diagonal Paraguay 362, 6th Floor, 8330077, Santiago, Chile
| | - Aditi Sahu
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sebastián Mondaca
- Department of Medical Oncology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.,Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Sergio Gonzalez
- Department of Pathology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Pablo Uribe
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Diagonal Paraguay 362, 6th Floor, 8330077, Santiago, Chile.,Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Cristian Navarrete-Dechent
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Diagonal Paraguay 362, 6th Floor, 8330077, Santiago, Chile. .,Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
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Casey M, Pollock R, Enright RH, O'Neill JP, Shine N, Sullivan P, Martin FT, O'Sullivan B. Metastatic and locally aggressive BCC: Current treatment options. Clin Case Rep 2021; 9:e04965. [PMID: 34691462 PMCID: PMC8517578 DOI: 10.1002/ccr3.4965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 09/22/2021] [Accepted: 10/04/2021] [Indexed: 11/08/2022] Open
Abstract
The treatment of locally advanced and metastatic BCC presents a significant clinical challenge. Treatment options have evolved recently to include the use of hedgehog inhibitors Vismodigib and Sonidigib and immunotherapy with Cemiplimab.
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Affiliation(s)
| | - Roisín Pollock
- Beaumont Head & Neck DepartmentBeaumont HospitalDublinIreland
| | | | | | - Neville Shine
- Beaumont Head & Neck DepartmentBeaumont HospitalDublinIreland
| | - Paul Sullivan
- Beaumont Head & Neck DepartmentBeaumont HospitalDublinIreland
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Cameron MC, Lee E, Hibler BP, Barker CA, Mori S, Cordova M, Nehal KS, Rossi AM. Basal cell carcinoma: Epidemiology; pathophysiology; clinical and histological subtypes; and disease associations. J Am Acad Dermatol 2018; 80:303-317. [PMID: 29782900 DOI: 10.1016/j.jaad.2018.03.060] [Citation(s) in RCA: 221] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 03/19/2018] [Accepted: 03/21/2018] [Indexed: 12/17/2022]
Abstract
As the most common human cancer worldwide and continuing to increase in incidence, basal cell carcinoma is associated with significant morbidity and cost. Continued advances in research have refined both our insight and approach to this seemingly ubiquitous disease. This 2-part continuing medical education article will provide a comprehensive and contemporary review of basal cell carcinoma. The first article in this series describes our current understanding of this disease regarding epidemiology, cost, clinical and histopathologic presentations, carcinogenesis, natural history, and disease associations.
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Affiliation(s)
- Michael C Cameron
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erica Lee
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Brian P Hibler
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christopher A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shoko Mori
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Miguel Cordova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kishwer S Nehal
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anthony M Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
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Paulsen JF, Øregaard JS, Nielsen AL, Gehl J, Venzo A. Vismodegib and surgery combined - effective treatment of locally advanced basal cell carcinoma. Acta Oncol 2016; 55:1492-1494. [PMID: 27448604 DOI: 10.1080/0284186x.2016.1206212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Aydin D, Hölmich LR, Jakobsen LP. Metastatic basal cell carcinoma caused by carcinoma misdiagnosed as acne - case report and literature review. Clin Case Rep 2016; 4:601-4. [PMID: 27398205 PMCID: PMC4891487 DOI: 10.1002/ccr3.575] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/24/2016] [Accepted: 04/15/2016] [Indexed: 11/17/2022] Open
Abstract
Basal cell carcinoma can be misdiagnosed as acne; thus, carcinoma should be considered in treatment-resistant acne. Although rare, neglected basal cell carcinoma increases the risk of metastasis.
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Affiliation(s)
- Dogu Aydin
- Department of Plastic and Reconstructive SurgeryHerlev‐Gentofte HospitalCopenhagen University HospitalCopenhagenDenmark
| | - Lisbet Rosenkrantz Hölmich
- Department of Plastic and Reconstructive SurgeryHerlev‐Gentofte HospitalCopenhagen University HospitalCopenhagenDenmark
| | - Linda P. Jakobsen
- Department of Plastic and Reconstructive SurgeryHerlev‐Gentofte HospitalCopenhagen University HospitalCopenhagenDenmark
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Zbacnik AP, Rawal A, Lee B, Werling R, Knapp D, Mesa H. Cutaneous basal cell carcinosarcoma: case report and literature review. J Cutan Pathol 2015; 42:903-10. [DOI: 10.1111/cup.12578] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 10/17/2011] [Accepted: 12/15/2011] [Indexed: 12/01/2022]
Affiliation(s)
| | - Ajay Rawal
- Department of Pathology; Minneapolis VA Health Care System; Minneapolis MN USA
| | - Bailey Lee
- Department of Dermatology; University of Minnesota; Minneapolis MN USA
| | - Robert Werling
- Department of Dermatology; University of Minnesota; Minneapolis MN USA
| | - Dennis Knapp
- Department of Pathology; Minneapolis VA Health Care System; Minneapolis MN USA
| | - Hector Mesa
- Department of Pathology; Minneapolis VA Health Care System; Minneapolis MN USA
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An unusual infiltrative basal cell carcinoma with osteoclastic stromal changes mimicking carcinosarcoma: a case report. Am J Dermatopathol 2014; 37:26-30. [PMID: 24786580 DOI: 10.1097/dad.0000000000000131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 91-year-old man presented with an ulcerated nodule on his left lower eyelid. The tumor showed an epithelial component composed of basaloid and clear cells and a stroma that contained many osteoclastic giant cells. Strong, diffuse expression for cytokeratin 17 and p63 was noted in the epithelial component, whereas no staining was present in the sarcomatoid stroma, suggesting that the osteoclast-rich stromal component represented an unusual benign stromal reaction to the carcinoma rather than a manifestation of carcinosarcoma. Further supporting this interpretation was the absence of mitotic figures and low Ki-67 proliferation index (of approximately 1%) in the stromal cells. We herein reported a case of unusual infiltrative basal cell carcinoma, accompanied by a clear cell carcinomatous features and concurrent benign osteoclastic stromal changes.
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Kaszkin-Bettag M, Hildebrandt W. Case reports on cancer therapies: the urgent need to improve the reporting quality. Glob Adv Health Med 2013; 1:8-10. [PMID: 24278810 PMCID: PMC3833504 DOI: 10.7453/gahmj.2012.1.2.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Current guidelines for certain cancer therapies mainly provide recommendations for therapy options treating the primary tumors. However, first-choice treatments for advanced or metastasizing tumors are described only rarely if at all. In such cases, one or more individual treatment options are chosen by the physician depending on the medical need of the patient and considering the acceptance of this treatment by the patient. Often, well-known drugs are selected with a different dosing than is indicated in the drug information leaflet. In other cases, drugs not yet approved for this particular type of cancer are used off label or certain therapies are used in combination or consecutively in a manner not reported before. With the increasing research on personalized medicine, particularly in treating cancer, case reports on innovative drug therapies or newly developed surgical interventions may provide extremely valuable information in instances where randomized controlled trials may not be feasible (eg, because of a low patient number or ethical considerations).
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Affiliation(s)
- Marietta Kaszkin-Bettag
- Marietta Kaszkin-Bettag, PhD, is a scientific expert and Heads of Preclinical/Medical Affairs & Health Technology Assessment PharmaLex GmbH, Manheim, Germany
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Suárez-Amor O. Letter: Comment on basal cell carcinoma of the scrotum: clinicopathologic analysis of 10 cases. Dermatol Surg 2013; 39:145. [PMID: 23301788 DOI: 10.1111/dsu.12052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Weiss GJ, Korn RL. Metastatic basal cell carcinoma in the era of hedgehog signaling pathway inhibitors. Cancer 2012; 118:5310-9. [PMID: 22511370 DOI: 10.1002/cncr.27532] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 02/10/2012] [Accepted: 02/13/2012] [Indexed: 01/30/2023]
Abstract
BACKGROUND Inhibition of the hedgehog signaling pathway (HHSP) for the treatment of locally advanced basal cell carcinoma (BCC) and metastatic BCC (mBCC) has produced promising results. Typically, mBCC is not taken into consideration during the workup of a patient with multifocal metastatic disease who has a history of BCC. The objective of the current review, in which the authors evaluated the time from the first BCC diagnosis to metastasis, location of disease, and radiographic features, was to contribute to the general knowledge and awareness among providers, patients, and support groups about mBCC and to provide an outlook for the future of treatments for mBCC. A literature review on mBCC and a review of records from patients with mBCC who presented to Virginia G. Piper Cancer Center Clinical Trials (an oncology clinical trials center) were conducted. The clinical and radiographic findings of 22 patients with mBCC who were evaluated at that center from the initiation of smoothened (SMO) antagonist trials were analyzed along with a review of BCC epidemiology and pathogenesis, the HHSP, and current and future treatments for this rare presentation of the most common malignancy. The results indicated that, in the last 5 years, there has been a plethora of new agents targeting SMO, a key component of the HHSP that, for the majority of patients with mBCC, may be a good match for targeting tumor genetic vulnerability. Like with other targeted therapy for uncommon malignancies, such as chronic myelogenous leukemia and gastrointestinal stromal tumors, the authors anticipate that there will be clinical development of next-generation HHSP inhibitors to combat mBCCs that are nonresponsive to or progress on current SMO antagonists.
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Affiliation(s)
- Glen J Weiss
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare, Scottsdale, Arizona; Translational Genomics Research Institute, Phoenix, AZ 85258, USA.
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An Overview of Mohs Micrographic Surgery for the Treatment of Basal Cell Carcinoma. Dermatol Clin 2011; 29:153-60, vii. [DOI: 10.1016/j.det.2011.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Suarez-Amor O, Monteagudo B, Cabanillas M, de las Heras C. Vulval location: an indication for staging in basal cell carcinoma? Australas J Dermatol 2009; 50:297; author reply 297-8. [PMID: 19916978 DOI: 10.1111/j.1440-0960.2009.00563.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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