Abstract
Purpose :
This case series evaluates the impact of vismodegib on the ocular environment following therapeutic response in patients with locally advanced basal cell carcinoma (BCC). It examines complications arising from tumor regression and approaches to their mitigation.
Methods :
We followed three patients with biopsy-confirmed BCC treated with vismodegib 150 mg daily. In cases where surgery or radiotherapy is not an option, vismodegib, a hedgehog pathway inhibitor, has been a promising therapy. Our series suggests that rapid regression after vismodegib treatment can lead to morbidity from exposure due to ocular changes.
Results :
The first patient presented with BCC involving the cheek, orbit and eyelid. She experienced rapid tumor regression on vismodegib. As the BCC involuted, she experienced significant cicatrix resulting in lower lid ectropion and exposure keratopathy. She underwent ectropion repair and radical lesion excision with skin graft. She developed further ectropion and punctal stenosis, treated with lateral tarsal strip and 3-snip procedures. Despite these measures, she eventually underwent evisceration due to exposure keratopathy. The second patient presented with extensive involvement of the left centrofacial region. The plan was to treat ectropion promptly to prevent worsening as the tumor involuted. Upon subsequent diagnosis of small cell lung carcinoma, vismodegib was stopped and he was temporarily lost to follow up. He experienced significant involution of the BCC while on carboplatin/etopisode for small cell lung carcinoma. This resulted in ectropion, treated with permanent tarsorrhaphy. The third patient presented with BCC extending from the temporal to mandibular region, with CN VII palsy and ectropion. He had tumor involution within days of starting treatment. He promptly underwent permanent tarsorrhaphy to address exposure. As the BCC involuted, the tarsorrhaphy thinned, necessitating a repeat tarsorrhaphy.
Conclusions :
The patients in this series demonstrated rapid responses to vismodegib, but the extent of fibrosis and scarring with tumor involution led to exposure concerns. Early surgical intervention to address exposure may mitigate the damage of these complications. Notably, significant involution of locally advanced nodular BCC was seen following carboplatin/etopisode therapy, suggesting that other chemotherapeutic agents may be treatment options.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.