Eight years of experience with vismodegib for advanced and multiple basal cell carcinoma patients in the Netherlands: a retrospective cohort study

Babette J A Verkouteren, Marlies Wakkee, An K L Reyners, Patty Nelemans, Maureen J B Aarts, Emőke Rácz, Jorrit B Terra, Lot A Devriese, Robert-Jan Alers, Ellen Kapiteijn, Remco van Doorn, Marcel W Bekkenk, Marie G H C Reinders, Klara Mosterd, Babette J A Verkouteren, Marlies Wakkee, An K L Reyners, Patty Nelemans, Maureen J B Aarts, Emőke Rácz, Jorrit B Terra, Lot A Devriese, Robert-Jan Alers, Ellen Kapiteijn, Remco van Doorn, Marcel W Bekkenk, Marie G H C Reinders, Klara Mosterd

Abstract

Background: Vismodegib has been used for the treatment of locally advanced basal cell carcinoma (laBCC) and metastatic BCC (mBCC) since 2011. Most efficacy and safety data are provided by clinical trials. This study evaluates the effectiveness of vismodegib for the treatment of laBCC, mBCC and basal cell nevus syndrome (BCNS) patients, and the tumour characteristics associated with a higher probability of achieving a complete response in the Netherlands.

Methods: A retrospective cohort study that included all patients ≥18 years with histologically proven basal cell carcinoma that received ≥1 dose of vismodegib between July 2011 and September 2019 in the Netherlands.

Results: In total, 48 laBCC, 11 mBCC and 19 BCNS patients were included. Median progression-free survival was 10.3 months (95% confidence interval (CI), 7.5-22.6) for laBCC, 11.7 (95% CI, 5.2-17.5) for mBCC and 19.1 (95% CI, 7.4-20.2) for BCNS. Larger laBCCs were associated with a lower probability of complete response (hazard ratio (HR) 0.77 per increase in cm, p = 0.02). Of all BCNS patients, 63% received ≥2 treatment sequences with vismodegib; all achieved partial responses.

Conclusions: Half of the aBCC patients progress within 1 year after the start of vismodegib treatment. More research is needed to investigate other treatment strategies after vismodegib progression and to evaluate long-term effects of repetitive vismodegib treatment.

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1. Swimmer plots of all individual…
Fig. 1. Swimmer plots of all individual patients per treatment indication.
Time is shown on the horizontal axes in months and individual patients are shown on the vertical axes. a Swimmer plot of locally advanced basal cell carcinoma patients. Patients 14, 21, 22 and 23 received vismodegib as neoadjuvant therapy. Patients 8, 20, 28, 31 and 43 are basal cell nevus syndrome patients. b Swimmer plot of metastatic basal cell carcinoma patients. c Swimmer plot of multiple basal cell carcinoma patients. Patients 20 and 21 are high-frequency basal cell carcinoma patients; patients 22, 23 and 24 are xeroderma pigmentosum patients.
Fig. 1. Swimmer plots of all individual…
Fig. 1. Swimmer plots of all individual patients per treatment indication.
Time is shown on the horizontal axes in months and individual patients are shown on the vertical axes. a Swimmer plot of locally advanced basal cell carcinoma patients. Patients 14, 21, 22 and 23 received vismodegib as neoadjuvant therapy. Patients 8, 20, 28, 31 and 43 are basal cell nevus syndrome patients. b Swimmer plot of metastatic basal cell carcinoma patients. c Swimmer plot of multiple basal cell carcinoma patients. Patients 20 and 21 are high-frequency basal cell carcinoma patients; patients 22, 23 and 24 are xeroderma pigmentosum patients.
Fig. 2. Kaplan-Meier curved of time-to-event analyses…
Fig. 2. Kaplan-Meier curved of time-to-event analyses per treatment indication.
(a) Progression-free survival by indication. (b) Partial response by indication. (c) Complete response by indication.

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