Vismodegib for giant, locally advanced, basal cell carcinoma and its complex position in clinical practice

In 2012 vismodegib (Erivedge), an oral hedgehog pathway inhibitor, was approved by the US Food and Drug Administration for the treatment of locally advanced or metastatic basal cell carcinoma (BCC).1 Marketing authorization, however, does not account for long-term obstacles as seen in daily clinical practice. For example, one dilemma is the positioning of vismodegib in the treatment of giant, locally advanced BCC, especially regarding its position as part of a palliative and curative treatment. Another issue is how to deal with tumor resistance to vismodegib in giant, locally advanced BCC in a specific group of patients who avoid health care, often because of fear of surgery or radiotherapy. Gaining insight in the treatment process of these patients is therefore urgently needed to improve decision making in these complex cases. We report on 3 patients treated with vismodegib for giant, locally advanced BCC and 1 patient treated for a metastasized BCC to illustrate and discuss the possibilities and limitations of vismodegib treatment in clinical practice.