Ocular preservation with neoadjuvant vismodegib in patients with locally advanced periocular basal cell carcinoma

Locally advanced (T4 per American Joint Committee on Cancer (AJCC) 8th edition) periocular basal cell carcinoma (BCC) can lead to loss of the eye. We report the neoadjuvant use of vismodegib followed by surgery in patients with such lesions with eye preservation as primary goal. This retrospective i...

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Vydáno v:British journal of ophthalmology Ročník 103; číslo 6; s. 775 - 780
Hlavní autoři: Sagiv, Oded, Nagarajan, Priyadharsini, Ferrarotto, Renata, Kandl, Thomas J, Thakar, Sudip D, Glisson, Bonnie S, Altan, Mehmet, Esmaeli, Bita
Médium: Journal Article
Jazyk:angličtina
Vydáno: England 01.06.2019
Témata:
Administration, Oral
Aged
Aged, 80 and over
Anilides - administration & dosage
Biopsy
Carcinoma, Basal Cell - diagnosis
Carcinoma, Basal Cell - therapy
Dose-Response Relationship, Drug
Eyelid Neoplasms - diagnosis
Eyelid Neoplasms - therapy
Eyelids - pathology
Eyelids - surgery
Female
Follow-Up Studies
Humans
Male
Middle Aged
Neoadjuvant Therapy
Neoplasm Staging
Ophthalmologic Surgical Procedures - methods
Pyridines - administration & dosage
Retrospective Studies
Treatment Outcome
treatment surgery
neoplasia
treatment medical
ISSN:0007-1161, 1468-2079, 1468-2079
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Abstract Locally advanced (T4 per American Joint Committee on Cancer (AJCC) 8th edition) periocular basal cell carcinoma (BCC) can lead to loss of the eye. We report the neoadjuvant use of vismodegib followed by surgery in patients with such lesions with eye preservation as primary goal. This retrospective interventional study includes all patients with a T4 periocular BCC (per 8th edition AJCC for eyelid carcinoma) treated by the senior author between 2013 and 2017 with neoadjuvant vismodegib prior to definitive surgery. Eight patients had a T4 tumour. Six patients presented with recurrent disease. Indications for neoadjuvant treatment were an unresectable tumour in one patient, an attempt to avoid an orbital exenteration in six patients and an attempt to avoid disfiguring facial surgery in one patient. Patients were treated for a median of 14 months (range: 4-36 months). All patients underwent an eye-sparing surgery following neoadjuvant vismodegib and all final surgical margins were negative for tumour. Five patients had a complete response to vismodegib with no microscopic residual BCC found during surgery; three patients had a significant partial response with residual tumour found on pathology. At last follow-up, a mean of 18 (range: 6-43) months after surgery, all patients were off-vismodegib and alive without evidence of disease. Neoadjuvant vismodegib for locally advanced (T4) periocular BCC enabled an eye-sparing surgery in all patients in our cohort. Prolonged treatment was well tolerated by most patients. Over half of patients achieved a complete response with no residual microscopic disease. Careful long-term follow-up is needed to confirm long-term disease-free survival.
AbstractList Locally advanced (T4 per American Joint Committee on Cancer (AJCC) 8th edition) periocular basal cell carcinoma (BCC) can lead to loss of the eye. We report the neoadjuvant use of vismodegib followed by surgery in patients with such lesions with eye preservation as primary goal. This retrospective interventional study includes all patients with a T4 periocular BCC (per 8th edition AJCC for eyelid carcinoma) treated by the senior author between 2013 and 2017 with neoadjuvant vismodegib prior to definitive surgery. Eight patients had a T4 tumour. Six patients presented with recurrent disease. Indications for neoadjuvant treatment were an unresectable tumour in one patient, an attempt to avoid an orbital exenteration in six patients and an attempt to avoid disfiguring facial surgery in one patient. Patients were treated for a median of 14 months (range: 4-36 months). All patients underwent an eye-sparing surgery following neoadjuvant vismodegib and all final surgical margins were negative for tumour. Five patients had a complete response to vismodegib with no microscopic residual BCC found during surgery; three patients had a significant partial response with residual tumour found on pathology. At last follow-up, a mean of 18 (range: 6-43) months after surgery, all patients were off-vismodegib and alive without evidence of disease. Neoadjuvant vismodegib for locally advanced (T4) periocular BCC enabled an eye-sparing surgery in all patients in our cohort. Prolonged treatment was well tolerated by most patients. Over half of patients achieved a complete response with no residual microscopic disease. Careful long-term follow-up is needed to confirm long-term disease-free survival.
Locally advanced (T4 per American Joint Committee on Cancer (AJCC) 8th edition) periocular basal cell carcinoma (BCC) can lead to loss of the eye. We report the neoadjuvant use of vismodegib followed by surgery in patients with such lesions with eye preservation as primary goal.BACKGROUND/AIMSLocally advanced (T4 per American Joint Committee on Cancer (AJCC) 8th edition) periocular basal cell carcinoma (BCC) can lead to loss of the eye. We report the neoadjuvant use of vismodegib followed by surgery in patients with such lesions with eye preservation as primary goal.This retrospective interventional study includes all patients with a T4 periocular BCC (per 8th edition AJCC for eyelid carcinoma) treated by the senior author between 2013 and 2017 with neoadjuvant vismodegib prior to definitive surgery.METHODSThis retrospective interventional study includes all patients with a T4 periocular BCC (per 8th edition AJCC for eyelid carcinoma) treated by the senior author between 2013 and 2017 with neoadjuvant vismodegib prior to definitive surgery.Eight patients had a T4 tumour. Six patients presented with recurrent disease. Indications for neoadjuvant treatment were an unresectable tumour in one patient, an attempt to avoid an orbital exenteration in six patients and an attempt to avoid disfiguring facial surgery in one patient. Patients were treated for a median of 14 months (range: 4-36 months). All patients underwent an eye-sparing surgery following neoadjuvant vismodegib and all final surgical margins were negative for tumour. Five patients had a complete response to vismodegib with no microscopic residual BCC found during surgery; three patients had a significant partial response with residual tumour found on pathology. At last follow-up, a mean of 18 (range: 6-43) months after surgery, all patients were off-vismodegib and alive without evidence of disease.RESULTSEight patients had a T4 tumour. Six patients presented with recurrent disease. Indications for neoadjuvant treatment were an unresectable tumour in one patient, an attempt to avoid an orbital exenteration in six patients and an attempt to avoid disfiguring facial surgery in one patient. Patients were treated for a median of 14 months (range: 4-36 months). All patients underwent an eye-sparing surgery following neoadjuvant vismodegib and all final surgical margins were negative for tumour. Five patients had a complete response to vismodegib with no microscopic residual BCC found during surgery; three patients had a significant partial response with residual tumour found on pathology. At last follow-up, a mean of 18 (range: 6-43) months after surgery, all patients were off-vismodegib and alive without evidence of disease.Neoadjuvant vismodegib for locally advanced (T4) periocular BCC enabled an eye-sparing surgery in all patients in our cohort. Prolonged treatment was well tolerated by most patients. Over half of patients achieved a complete response with no residual microscopic disease. Careful long-term follow-up is needed to confirm long-term disease-free survival.CONCLUSIONSNeoadjuvant vismodegib for locally advanced (T4) periocular BCC enabled an eye-sparing surgery in all patients in our cohort. Prolonged treatment was well tolerated by most patients. Over half of patients achieved a complete response with no residual microscopic disease. Careful long-term follow-up is needed to confirm long-term disease-free survival.
Author Glisson, Bonnie S
Sagiv, Oded
Altan, Mehmet
Thakar, Sudip D
Ferrarotto, Renata
Kandl, Thomas J
Esmaeli, Bita
Nagarajan, Priyadharsini
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Snippet Locally advanced (T4 per American Joint Committee on Cancer (AJCC) 8th edition) periocular basal cell carcinoma (BCC) can lead to loss of the eye. We report...
Locally advanced (T4 per American Joint Committee on Cancer (AJCC) 8th edition) periocular basal cell carcinoma (BCC) can lead to loss of the eye. We report...
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SubjectTerms Administration, Oral
Aged
Aged, 80 and over
Anilides - administration & dosage
Biopsy
Carcinoma, Basal Cell - diagnosis
Carcinoma, Basal Cell - therapy
Dose-Response Relationship, Drug
Eyelid Neoplasms - diagnosis
Eyelid Neoplasms - therapy
Eyelids - pathology
Eyelids - surgery
Female
Follow-Up Studies
Humans
Male
Middle Aged
Neoadjuvant Therapy
Neoplasm Staging
Ophthalmologic Surgical Procedures - methods
Pyridines - administration & dosage
Retrospective Studies
Treatment Outcome
Title Ocular preservation with neoadjuvant vismodegib in patients with locally advanced periocular basal cell carcinoma
URI https://www.ncbi.nlm.nih.gov/pubmed/30021814
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