The Evolution of Advanced Basal Cell Carcinoma Care

In an eye-opening conversation with Dermatology Times, Dr. Vishal Patel, a leading oncologist and Mohs surgeon at the George Washington University School of Medicine, sheds light on the revolutionary changes in treating advanced basal cell carcinoma (BCC). His expertise and innovative approach at the GW Cancer Center highlight the increasing reliance on hedgehog pathway inhibitors and a patient-focused strategy as the medical community navigates this rapidly advancing field.

Understanding the Complexities of Treatment

When it comes to locally advanced BCC, Dr. Patel emphasizes that 'challenge' begins with the very definition of the disease. He explains that while large tumors can pose significant treatment obstacles—especially on the head and neck—smaller lesions can be equally, if not more, difficult. In the U.S., BCC is traditionally categorized as advanced, recurrent, or amenable to surgery, while European standards focus on the complexity of the tumor, leading to distinctions between 'easy' and 'difficult' cases.

Dr. Patel shares, "I often face smaller yet challenging lesions, questioning whether surgical intervention is the best option. With an aging population and an alarming rise in BCC cases among younger patients—even those in their teens—we’re witnessing a wider spectrum of disease presentation, along with emotional and psychosocial challenges that can complicate treatment pathways."

The Treatment Landscape: Past, Present, and Future

Historically, surgical options like Mohs micrographic surgery have been the gold standard in BCC treatment in the U.S. However, as Dr. Patel points out, ‘surgery’ is not a one-size-fits-all solution. Advances in non-surgical modalities—including lasers and light therapies—are gaining traction, particularly as he explores the effective use of systemic therapies like hedgehog pathway inhibitors.

With years of experience using these treatments, he’s also integrating immunotherapy into his treatment plans, underscoring a paradigm shift in patient care.

Sonidegib: A Game-Changer in BCC Therapy

One specific treatment, sonidegib (marketed as Odomzo), shines in this evolving landscape. As Dr. Patel explains, it is intended for patients with locally advanced BCC who aren't candidates for surgery or radiation. Its rapid absorption and effectiveness position it as a vital option in difficult cases, providing flexibility in treatment decisions and addressing both medical and emotional needs of patients.

Balancing Risks and Patient Values

Navigating the doctor-patient relationship is key when discussing treatment strategies. Dr. Patel emphasizes that understanding a patient's values is vital—if the patient prioritizes complete tumor removal, surgery might be the sole option. However, many patients view their diagnosis through a chronic disease lens, much like diabetes, which opens the door to systemic therapies that manage tumor growth while minimizing aggressiveness.

Preparing for a Bright Future in BCC Treatment

The excitement surrounding advancements in BCC therapy is palpable, and Dr. Patel is optimistic about the next five years. He envisions combining hedgehog inhibitors with other therapeutic approaches to elevate complete response rates, aiming for levels as high as 70% to 80%. As researchers gather more data, exploring optimal dosing regimens could further enhance treatment efficacy while reducing side effects.

In the medical community, practicing innovation responsibly remains paramount. Dr. Patel's philosophy centers on minimizing the need for invasive procedures unless absolutely necessary, reflecting a commitment to patient-centered care.

A Cautionary Note on Sonidegib

While sonidegib is a powerful ally in the fight against BCC, there are important considerations for its use, particularly regarding pregnancy-related risks. Patients must work closely with their healthcare providers to understand these warnings and implement necessary precautions.

As the field of dermatologic oncology continues to evolve, Dr. Patel’s insights and experiences offer a beacon of hope for better patient outcomes and an improved quality of life for those facing the challenges of basal cell carcinoma.