By Gary M. White, MD
Note, this is a brief summary only and is meant to emphasize dermatologic aspects. More complete information, including the package insert and recent studies should be consulted before prescribing.
Eviredge (vismodegib) is an oral medication (Hedgehog pathway inhibitor) that has become first line therapy for basal cell carcinoma that can't be resected nor irradiated.
- Vismodegib is given 150 mg once daily.
- The mean treatment duration in one study was 8.6 months.
- Side effect are significant including muscle spasms, alopecia and dysgeusia (distortion of taste).
- One gives the drug until the patient is histologically-clear/disease-free, or, until there is disease progression or intolerable side effects.
- Some clinicians have resorted to off-label every-other-month dosing schedule to diminish side effects.
- About 50% of patients stop the drug because of side effects.
- Eviredge be combined with surgery or topical chemotherapies/immune modulators to reduce the size of the basal cell carcinoma (BCC) that needs to be treated.
- It is highly teratogenic. Verify a woman is not pregnant.
Indicated for basal cell carcinoma which has metastasized to other parts of the body, relapsed after surgery, or cannot be treated with surgery or radiation.
Off Label Indications
- Some use vismodegib to shrink BCCs prior to surgery. Given for 3 months or more [JAAD 2014;71;904].
- Basal cell nevus syndrome.
Side Effects (selected, not a complete list)
- Muscle spasm: Note that amlodipine can decrease the frequency of muscle cramps [JAMADerm 2015;151;1132].
- Dysgeusia (distortion of sense of taste).
- Stomach upset.
- Highly teratogenic. Pregnancy Category X. (Don't get pregnant.)
- Increased risk of cutaneous squamous cell carcinoma. One study found a hazard ratio of 8.1 for developing non-BCC skin cancer (mostly SCC) in patients treated with vismodegib for BCC [JAMA Derm 2016;527].
Is there hepatotoxicity? A post marketing report indicated a significant number of cases of hepatotoxicity (J Am Acad Dermatology Aug 2014).
Squamous Cell Carcinoma
Patients have been described who develop squamous cell carcinoma (SCC) within the tumor bed of a responding BCC. Thus, repeat biopsy is indicated when one area does not respond/grows in the tumor bed or when a tumor stops being suppressed by vismodegib [JAMA Derm 2014;150;970].
150 mg once daily.
None required except for pregnancy testing if indicated.
Case report of resolution of keratocysts of the jaw in basal cell nevus syndrome. In one report of 6 patients treated, 4 experienced a size reduction and 2 had no change [JAMA Dermatol. 2014 May;150(5):542-5.].
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