NEW YORK (Reuters Health) - Receiving vismodegib therapy for advanced basal cell carcinoma (BCC) may put patients at increased risk of later developing cutaneous squamous cell carcinoma (CSCC), according to a new study.
"Primary care physicians and oncologists should work closely with dermatologists to make sure that patients on this chemotherapy are carefully followed for development of additional skin cancers," said Dr. Anne Lynn S. Chang from Stanford University College of Medicine in Redwood City, California.
"Clinicians should tell their patients to look for new growths on their skin, especially those that don't resolve after one month," she told Reuters Health by email.
Vismodegib, a Hedgehog pathway inhibitor, is a novel treatment for BCC when surgery or radiation is contraindicated.
Dr. Chang and colleagues conducted a case-control study at Stanford Medical Center involving high-risk patients with BCC diagnosed between 1998 and 2014. Exposed patients had confirmed prior treatment with vismodegib and controls had not received the treatment.
The researchers compared 55 cases with 125 controls, adjusting for age, sex, prior radiation therapy or cisplatin treatment and other potential confounders, according to an article online February 24 in JAMA Dermatology.
The researchers found that exposed patients had a hazard ratio of 6.37 (p<0 .001="" 8.12="" a="" accounting="" after="" age="" and="" basal="" being="" cell="" cscc="" developing="" for="" malignancy="" most="" nevus="" non-bcc="" of="" p="" syndrome="" those="" with="">
They found the mean age of cases to be significantly younger than controls at the time of BCC diagnosis (52 versus 59, p<0 .001="" 0.8="" and="" bcns="" cases="" controls="" diagnoses="" had="" more="" p="" than="" versus="">0>
"While patients with BCNS were diagnosed as having BCC at an earlier age than nonsyndromic patients, this age difference was still significant after BCNS was controlled for. Because age is also significantly associated with general cancer risk, this covariate was adjusted for in subsequent analysis," the researchers wrote.
Dr. Chang advises doctors to "have a low threshold to refer your oncology patients to a dermatologist who can perform a full skin examination, particularly in areas that patients may not be able to see themselves, such as the top and back of scalp and the back."
In an accompanying opinion article, Dr. Martin Leverkus of the RWTH Aachen University, North Rhine/Westphalia, Germany, and colleagues write, "As the benefit of vismodegib is substantial for most patients who lack alternatives for the treatment of advanced BCC, we need to be aware that the therapeutic success potentially comes at a neoplastic price. Future efficiency in trial design may be gained by prospective matched pairs analysis adjusting for confounders and by using validated surrogate endpoints established from the current data."
The authors reported no funding. Dr. Chang reported financial relationships with Genentech, which markets vismodegib as Erivedge.
SOURCE: http://bit.ly/24rpMOU and http://bit.ly/1TB1Wer
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