In patients with advanced basal cell carcinoma and basal cell nevus syndrome, treatment with vismodegib every weekday and withholding therapy during the weekend results in fewer adverse effects and is associated with a longer average time to onset of adverse effects than daily dosing, study research published in the Journal of the American Academy of Dermatology reports.
In this retrospective review of a case series from the Cleveland Clinic Foundation, the researchers reviewed the data of 21 patients aged 17 to 97 years with locally advanced basal cell carcinoma or basal cell nevus syndrome treated with vismodegib. A total of 8 patients were treated with 150 mg vismodegib from Monday through Friday with a 2-day drug holiday on Saturday and Sunday. The remaining 13 patients were initially treated with 150 mg vismodegib per day.
Overall, patients who were treated Monday through Friday had comparable clinical responses and a generally milder degree of adverse effects than the daily dose group. No patient in the Monday through Friday group experienced severe adverse effects, whereas 38% of patients in the daily group experienced severe adverse effects. On average, the initial time to onset of adverse effects was 7.7 weeks, and 6.4 weeks in the Monday through Friday dosing group and the daily dosing group, respectively. Dysgeusia, hair loss, muscle cramps, gastrointestinal upset, and weight loss affected 81% (N=17) of patients. Only 3 patients discontinued therapy because of adverse effects.
Limitations of the study were the small sample size, lack of randomization, and absence of standardizations for treatment regimens.
On the basis of their findings, the researchers wrote that “an intermittent weekend holiday for vismodegib dosing should be considered in patients with advanced basal cell carcinoma and basal cell nevus syndrome as monotherapy, neoadjuvant therapy, or palliative therapy.”
Wong C, Poblete-Lopez C, Vidimos A, et al. Comparison of daily dosing vs. Monday through Friday dosing of vismodegib for locally advanced basal cell carcinoma and basal cell nevus syndrome: A retrospective case series [published online February 21, 2020]. J Am Acad Dermatol. doi:10.1016/j.jaad.2020.02.050