Dr Todd Schlesinger Discusses Treatments for Advanced Skin Cancers

For cases of advanced skin cancer that are not candidates for surgery or radiation therapy, we have Hedgehog pathway inhibitors and PD-1 inhibitors, each of which has 2 approved medications, noted Todd Schlesinger, MD, FAAD, director, Dermatology and Laser Center of Charleston and Clinical Research Center of the Carolinas.

Schlesinger presented “Managing Advanced Non-Melanoma Skin Cancer - Choosing the Right Pathway for the Right Patient,” at this year’s American Academy of Dermatology Virtual Meeting Experience.

Transcript

What drug classes are used to treat advanced skin cancers?

So by advanced skin cancer, we’re talking about skin cancers that are not necessarily candidates for surgery or radiation therapy. Also, skin cancers that may be locally advanced and/or metastatic. The metastatic rate for squamous cell carcinoma hovers between 3% and 5%, and the metastatic rate for basal cell carcinoma is well less than 1%. But many tumors that we see in our practice may have been treated with other modalities if they are advanced, such as chemotherapy, radiation therapy, or prior surgery.

We have 2 major classes of medical therapies now that we can use for these advanced cases. One class is the Hedgehog pathway inhibitor class, of which we have 2 approved medications, and the other class is the PD-1 inhibitor pathway, of which we also have 2 approved medications. These are the kinds of medicines that would be used.

For the Hedgehog inhibitors, we have vismodegib and sonidegib. Both these medications have their pluses and minuses and are typically used for the medium to long term for patients with advanced basal cell carcinoma. And then for both squamous cell carcinoma and basal cell carcinoma, the PD-L1 pathway, or the checkpoint inhibitor pathway, is also used. These drugs are given by IV [intravenous] infusion as opposed to the Hedgehog pathway inhibitors, which are given orally.

The IV infusion medications, like the Hedgehog pathway [inhibitors], have their own set of adverse events that we have to watch for. For both medications, adverse events can occur, will occur frequently, in many to most patients, and the key to managing the adverse events is to recognize them early and intervene early with the medications.