Individualized Therapy Improves Cancer Outcomes

In treating rare advanced skin cancers, individualized therapy is improving outcomes.
There is consistent effort nationally to educate people about melanoma, which accounts for only 1 percent of all skin cancers yet is the cause of most skin cancer deaths. But many of us would be hard-pressed to name another form of skin cancer.

We tend not to hear as much about basal cell and squamous cell carcinomas, cancers that arise from a host of potential risk factors — the main one being exposure to ultraviolet light from the sun or tanning lamps — mainly because they are limited to the skin and thus are usually treatable with surgery or radiation, rarely progressing to an advanced stage. Still, these cancers, like melanoma, can become metastatic, and once they reach stage 4, the treatment options are less clear.

Just 0.5 percent of basal cell carcinomas spread beyond the skin, often in patients who have compromised immune systems (such as those who have HIV/AIDS or have undergone organ transplants). Among patients with squamous cell skin cancers, 5 percent eventually develop metastatic disease; similar to the demographic in basal cell carcinoma, patients who have undergone solid organ or bone marrow transplants are most at risk for squamous cell disease.

For a long time, the rarity of these two conditions meant that treatment options were severely limited. Now, however, there are targeted drugs capable of treating basal cell and squamous cell cancers that have metastasized — with immunotherapies waiting in the wings.

Morganna Freeman, D.O., associate director of the Melanoma and Cutaneous Oncology Program at The Angeles Clinic, in California, discussed the latest strategies in an interview with CURE®.

Let's start by discussing treatments for basal cell carcinoma. Please give us the basics about a ket recent strategy, the use of targeted drugs called hedgehog inhibitors.

Dr. Freeman: About 20 years ago, it was discovered that there were abnormal genes in basal cell cancers that controlled a “hedgehog cell signaling pathway” which is essential to basal cell growth. This pathway is activated by a protein called “smoothened,” which can be blocked with targeted therapy to prevent cancer growth. Currently, we have two hedgehog inhibitors — Erivedge (vismodegib), approved by the FDA in 2012, and Odomzo (sonidegib), approved in 2015 — which target this protein and can kill basal cells successfully. These drugs are not like chemotherapy because, instead of interfering with DNA replication, they block a growth pathway the tumors are addicted to. Based on the data we have seen with both drugs, patients with advanced, unresectable and metastatic basal cell cancers can get a long-lasting clinical benefit with a fairly tolerable side-effect profile.

Talk about this article with other patients, caregivers, and advocates in the Skin Cancer CURE discussion group.
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