An update on the current and emerging pharmacotherapies for basal cell carcinomas

ABSTRACT

Introduction

Despite surgical approach is still the mainstay for basal cell carcinoma (BCC) management, several issues may limit the use of this technique, leading to the need for new treatments to offer patients a personalized approach.

Areas covered

A comprehensive review of the available and emerging pharmacologic strategies for BCC management, including mechanisms of action, and potential adverse effects, has been performed to provide with an up-to-date manuscript on the current treatment scenario of BCC. Globally, targeting the Sonic-Hedgehog pathway is one of the main mechanisms of action of currently investigated drugs. Other alternatives are based on the concept of an enhancement of the immune response such as immune checkpoint inhibitors, or intra-tumor treatments.

Expert opinion

Although low-risk BCCs are often treated with destructive methods or topical treatments, surgery is the mainstay of treatment for the majority of BCCs. However, several factors may limit the use of surgery in BCC management. Recently, major knowledge on BCCs pathogenesis has led to the development of effective and selective drugs. In our opinion, soon many drugs will be licensed, allowing clinicians to offer patients with BCC the right treatment at the right moment. Certainly, further studies are needed.

KEYWORDS:

• Basal cell carcinoma
• treatment
• emerging therapies
• pharmacotherapies
• personalized medicine

Article highlights

• Several treatment options have been proposed for BCC, with three principal purposes: oncological efficacy, acceptable aesthetic results, and functional preservation of organs.

• Despite surgical approach is still the mainstay for BCC management, several issues may limit the use of this technique, leading to the need for new treatments.

• Recently, Hedehog inhibitors (vismodegib and sonidegib) and anti-PD1 (cemiplimab) have been authorized. However, adverse events are frequent, as well as cases of resistance to treatment have been reported.

• Thanks to the major knowledge on BCC pathogenesis, targeted topical, intra-tumoral and systemic therapies have been developed, with several clinical trials currently ongoing.

• In our opinion, in the near future many drugs will be licensed, allowing clinicians to offer patients with BCC the right treatment at the right moment.

Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

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

Additional information

Funding

This paper was not funded.