Advances in the drug management of basal cell carcinoma

ABSTRACT

Introduction

Basal cell carcinoma (BCC) is the most common skin cancer in humans. Recently, BCCs were suggested to be classified into ‘easy to treat’ and ‘difficult to treat,’ and different therapeutic options are suggested for their management.

Areas covered

In this review, the authors discuss treatment options that are approved, recommended for, or are still in development for treatment of BCC. The review covers approved local therapies, such as imiquimod and 5-fluorouracil, and systemic therapies, such as hedgehog inhibitors. New medical agents, investigated in clinical trials, are reviewed. These include: targeted therapies, such as GLI antagonists or anti-VEGFR agents, immunotherapies, such as checkpoint inhibitors, recombinant cytokines or silencing RNA, as well as intralesional virotherapies with modified adeno- or herpes viruses.

Expert opinion

The progress made in recent years has improved the management of patients with advanced BCC; however, neither tumor targeting nor immune system engaging agents provide a cure. New treatment approaches directed not only to known targets but also the tumor microenvironment are in development and are anticipated to improve the management of difficult to treat BCC.

KEYWORDS:

• Basal cell carcinoma
• hedgehog pathway inhibitors
• skin cancer
• NMSC

Article highlights

• Basal cell carcinoma (BCC) is the most common cancer in humans.

• Mutations in the hedgehog pathway are most common mutations in BCCs.

• Most BCCs can be treated by surgery or other local approaches.

• A small percentage of BCCs advance locally or build metastases.

• In advanced BCC cases, systemic therapy with hedgehog pathway inhibitors are indicated.

• New therapeutic approaches, including immune checkpoint inhibitors, show promising results in clinical trials.

This box summarizes key points contained in the article.

Declaration of interest

E Ramelyte disclosures support through project focused grants, through advisory relations and/or by travel support from Amgen Inc, Sunpharma, Merck Sharp and Dohme, and Pierre Fabre. MP Levesque meanwhile is supported by project-related grants from Roche, Novartis, Molecular Partners and Oncobit. Finally, R Dummer has received project-related funding from Merck Sharp and Dohme, Bristol-Myers Squibb, Novartis, Roche, Amgen Inc, Takeda, Pierre Fabre, Sanofi, and CatalYm GmbH. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.