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Research Letters | Nov 2012 ONLINE FIRST

Initial Assessment of Tumor Regrowth After Vismodegib in Advanced Basal Cell Carcinoma

Anne Lynn S. Chang, MD; Anthony E. Oro, MD, PhD

Arch Dermatol. 2012;148(11):1324-1325. doi:10.1001/archdermatol.2012.2354.

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Secondary (acquired) resistance of a tumor to a chemotherapeutic agent is characterized by regrowth of a tumor after initial shrinkage. This is distinct from primary resistance, in which a tumor never responds to treatment, a separate topic from our current study. The Smoothened (SMO) inhibitor, vismodegib (GDC-0449), has recently been shown to be useful in phase 1 and 2 clinical trials¹^- 3 for locally advanced basal cell carcinomas (laBCCs) (defined as inoperable owing to multiple postsurgical recurrences or incurable with surgery without significant deformity or loss of function) or metastatic BCCs (mBCCs). Collectively, laBCCs and mBCCs are termed advanced BCCs, and vismodegib treatment was approved in 2012 by the US Food and Drug Administration for this indication. Our case series describes a previously unreported phenomenon of BCC tumor regrowth within or immediately adjacent to (within 1 cm) the prior tumor bed of a vismodegib-responsive tumor while the patient is still undergoing continuous vismodegib treatment. We call this phenomenon secondary (acquired) resistance.⁴

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Figure. A 67-year-old man with tumor regrowth. A, Nodular basal cell carcinoma (BCC) on right forehead prior to treatment. B, The BCC responded to vismodegib and healed, leaving a depressed scar shown here after 7 months of treatment. C, After 12 months of continuous vismodegib therapy, 2 biopsy-proven BCCs developed within the boundaries of the prior tumor, one a superficial and nodular subtype (upper arrow), and the other a nodular subtype (lower arrow).

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Chang AS, Oro AE. Initial Assessment of Tumor Regrowth After Vismodegib in Advanced Basal Cell Carcinoma. Arch Dermatol. 2012;148(11):1324-1325. doi:10.1001/archdermatol.2012.2354.

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