Metastatic basal cell carcinoma: report of two cases treated with cetuximab

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Conflicts of interest: none declared. SIR, Metastatic basal cell carcinoma (mBCC) is a very rare condition, the treatment of which is not codified although many systemic cytotoxic drugs have been used with poor clinical efficacy.1 2–3 The frequent overexpression of epidermal growth factor receptor (EGFR) in BCC4 along with individual reports of anti‐EGFR targeted therapy (cetuximab) in cases of locally advanced or metastatic skin epithelial tumours prompted us to use this antibody in two cases of mBCC as a palliative approach in an attempt to evaluate the benefit/risk ratio. A white 45‐year‐old man who was human immunodeficiency virus (HIV)‐positive had been initially treated in 1995 by surgery alone for sclerotic BCC of the nose. After two surgically removed local recurrences and a third relapse treated by radiotherapy and systemic chemotherapy with cisplatin and 5‐fluorouracil, secondary lesions developed in the parotid glands followed by multiple lung and bone metastases. Chemotherapy with paclitaxel, carboplatin and finally methotrexate was interrupted because of a poor response after initial stabilization. Cetuximab was then considered due to an overexpression of EGFR in both primary and secondary tumours and it was administered intravenously at a weekly dosage of 250 mg m−2. The treatment was well tolerated and morphological investigations after 2 months of this regimen showed no change in metastases. After 5 months of weekly cetuximab, lung lesions were stable but the general status of the patient rapidly declined and he finally died of sepsis.

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