INTRODUCTION
Basal cell carcinoma (BCC) is the most prevalent cancer worldwide.1 The mainstay of treatment is surgical excision or Mohs micrographic surgery but patients may develop advanced BCC such that surgical intervention, curettage, electrodesiccation, radiotherapy, or superficial field therapies are not practical.2 Locally advanced BCC (laBCC) tumors are aggressive BCCs that are large, grow deep into tissue, and/or are in difficult-to-treat locations.2 Patients with laBCC that receive surgical treatment may result in damaging deformities, loss of function, and substantial morbidity.2-4
Hedgehog inhibitors (HHIs) have emerged as a treatment option for patients with laBCC who are not candidates for surgery or radiation therapy or whose tumors have recurred following radiation or surgery.5 There are two oral HHIs currently approved by the FDA, vismodegib (approved 2012) and sonidegib (approved 2015).6-8 Despite known efficacy, HHIs have a high discontinuation rate due to adverse events.6,9 The purpose of this expert consensus panel was to review the literature on HHIs to provide guidance on their usage, thereby informing clinical decision-making and optimizing patient care in the management of BCC. As there are no head-to-head trials between vismodegib and sonidegib, the comparison between the two drugs by the expert panel was limited to available published literature.
Hedgehog inhibitors (HHIs) have emerged as a treatment option for patients with laBCC who are not candidates for surgery or radiation therapy or whose tumors have recurred following radiation or surgery.5 There are two oral HHIs currently approved by the FDA, vismodegib (approved 2012) and sonidegib (approved 2015).6-8 Despite known efficacy, HHIs have a high discontinuation rate due to adverse events.6,9 The purpose of this expert consensus panel was to review the literature on HHIs to provide guidance on their usage, thereby informing clinical decision-making and optimizing patient care in the management of BCC. As there are no head-to-head trials between vismodegib and sonidegib, the comparison between the two drugs by the expert panel was limited to available published literature.
MATERIALS AND METHODS
Literature Search and Study Selection
A comprehensive literature search of PubMed, Scopus, and Google Scholar was completed on May 1, 2024, using