Targeted therapy shows promise for basal and squamous cell carcinoma

The authors reviewed the literature on the clinical results of targeted therapy for orbital and periocular basal cell carcinoma and squamous cell carcinoma and conclude that it shows significant promise in the treatment of these conditions. They say such targeted therapy, which is still in its early phase of use, may be appropriate for patients who are not good candidates for surgery.

Vismodegib, an inhibitor of the transmembrane protein smoothened, targets the mutated patched 1 gene and sonic hedgehog pathway implicated in basal cell carcinoma. Vismodegib has been shown to cause marked basal cell carcinoma regression and, in some cases, complete regression, most notably of basal cell nevus syndrome.

Epidermal growth factor receptor overexpression has been demonstrated in squamous cell carcinomas. These inhibitors (cetuximab, erlotinib, gatifinab) have been shown effective in the treatment of both primary and metastatic tumors and have roles in the treatment of periocular and orbital basal and squamous cell carcinoma.

The authors describe successful outcomes after vismodegib treatment in a patient with basal cell nevus syndrome with numerous bulky lesions of the eyelid and periocular region. They write that while systemic chemotherapy results in significant cytotoxic affects, targeted therapy is associated with fewer side effects and is better tolerated by patients.

They conclude that targeted therapy will likely be an important addition to their armamentarium for managing orbital and periocular cutaneous carcinomas.