Efficacy and Safety of Hedgehog Inhibitors for Advanced Basal Cell Carcinoma: An Expert Consensus Panel

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BACKGROUND: Hedgehog inhibitors (HHIs) can be used to treat patients with locally advanced basal cell carcinoma (laBCC) who are not candidates for surgery or radiation or whose tumors have recurred following radiation or surgery. The purpose of this expert consensus panel is to guide HHI usage, thereby informing clinical decision-making and optimizing patient care. METHODS: A comprehensive literature search was completed on May 1, 2024, using the keywords "basal cell carcinoma," "hedgehog inhibitor," "sonidegib," and "vismodegib". A panel of eight dermatologists with significant expertise in the treatment of BCC gathered to review the articles and create consensus statements. A modified Delphi process was used to approve each statement and a strength of recommendation was assigned. RESULTS: The literature search produced 200 articles. A screening of the studies resulted in 19 articles that met the criteria. The panel unanimously voted to adopt 8 consensus statements and recommendations, two were given a strength of "A", three were given a strength of "B", and three were given a strength of "C". CONCLUSION: Sonidegib and vismodegib are FDA-approved HHIs that can decrease the size of laBCC tumors prior to surgical intervention or be used as primary therapy in certain circumstances. The most common adverse events include muscle spasms, alopecia, and taste alterations. CITATION: Burshtein J, Shah M, Zakria D, et al. Efficacy and safety of hedgehog inhibitors for advanced basal cell carcinoma: an expert consensus panel. J Drugs Dermatol. 2025;24(5):465-471. doi:10.36849/JDD.8827.

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