Choosing the Right Path for Skin Cancer Treatment

In the realm of skin cancer, basal cell carcinoma (BCC) tops the list as the most frequent malignant tumor in white populations. This type of cancer is driven by the abnormal activation of the Hedgehog signaling pathway. The good news is that this pathway can be blocked, offering a promising target for treatment. In Italy, doctors have two main weapons in their arsenal: Hedgehog inhibitors (HhIs) called vismodegib and sonidegib. To get a better understanding of how doctors choose between these two treatments, a survey was conducted in November 2020. This survey involved 33 clinicians from 27 different hospitals. Each participant had to answer two multiple-choice questions about the clinical effectiveness and safety of sonidegib and vismodegib.The survey revealed that doctors prioritize the overall response rate (ORR) and the duration of response (DoR) when deciding on treatment for locally advanced BCC (laBCC). These factors are crucial for both dermatologists and oncologists. The different ways these drugs are processed in the body lead to different side effects. Doctors often adjust the dose and schedule to manage these side effects, which influences their choice between vismodegib and sonidegib. The BOLT trial, a pivotal phase-II study, provided valuable data on the efficacy and tolerability of these drugs. This data is instrumental in guiding treatment choices for patients with laBCC. However, it's important to note that while ORR and DoR are key factors, they are not the only ones. The unique pharmacokinetic profiles of vismodegib and sonidegib also play a significant role in treatment decisions. The survey highlighted that doctors are well-versed in the nuances of these treatments. They understand that adjusting the dose and schedule can help mitigate side effects, making treatment more bearable for patients. This knowledge is crucial in the fight against BCC, ensuring that patients receive the best possible care.