First-line treatment options for laBCC



Anna C. Pavlick, DO: Over time, we were able to fill our treatment option box with 2 instruments for treating these patients. The first drug to be approved by the FDA 8 to 10 years ago was a class of drugs called hedgehog inhibitors. Hedgehog inhibitors are oral pills. They are tiny pills that patients take on a daily basis that essentially block the path that 99% of all basal cell carcinomas use to grow. What do i mean by that? There are so-called metabolic pathways or roads that the cancer cells or the basal cells use. As they walk these streets, they receive signals from the cells that say, “Keep growing. Spread it further. ”This is an important goal for us to stop the growth because if we know what stimulus is causing the cell to grow – if we block that stimulus, if we block the signal – we can stop the cancer from growing . This is how hedgehog inhibitors evolved. Hedgehog inhibitors block this signal, preventing the basal cell carcinoma from growing, regressing, shrinking, and possibly either disappearing or becoming small enough to make it easier for our dermatologist or surgeon to surgically remove it.

Hedgehog inhibitor drugs are considered the first line of therapy for patients with inoperable or locally advanced or metastatic basal cell carcinoma. A lot of people will say, “It’s a pill so it has to be easy to take.” A pill is always easy to take for most patients, but hedgehog inhibitors have several side effects that may be difficult to manage for our elderly patients as many of our patients are between 70 and 95 years old. Keep in mind that as you age, DNA damage builds up on your skin, which can predispose this group of patients to skin cancer.

When we see our patients with these large locally advanced or metastatic basal cell carcinomas we can offer them hedgehog inhibitors, but we must be very careful as some of the side effects of hedgehog inhibitors include changes in taste, loss of appetite, muscle cramps, and hair loss. Most of our elderly patients already have some leg cramps due to circulatory problems, so they are not unfamiliar with leg cramps. But when you have an elderly, very frail patient who is already very thin and older, you can sometimes have a big impact on their quality of life if you influence their taste buds and take away the pleasure of eating. When you rob them of the ability to eat, they lose a sense of contentment. It robs you of the opportunity to connect with other people and you now have an elderly person who doesn’t enjoy their meals, who just doesn’t feel like eating. When they want to eat, everything tastes like-

Basically, patients tell me that it tastes like metal.

You can lose weight. They can be weakened and we can affect their quality of life while we cure their cancer, which makes the patient worse. How long we can treat these patients and whether we should treat these patients with these medicines can be a very delicate balance. The answer is that it is an individual choice. Sometimes we have to do that. Sometimes it works well when patients say: “I have no side effects and see how good my tumor looks.” Then there are some patients who complain to us after a short time. They say, “I stopped eating,” and that can probably be very problematic for patients.

Transcript edited for clarity.



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