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Gorlin Syndrome/BCC — SCE Medical Oncology MCQ

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HardMelanoma & SkinGorlin Syndrome/BCCSCE Medical Oncology

A patient with unresectable locally advanced basal-cell carcinoma initially responds to vismodegib but then progresses. Further surgery or radiotherapy would be excessively morbid. Which treatment is licensed in the UK after hedgehog-pathway-inhibitor progression or intolerance?

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Correct answer: C — Cemiplimab, a PD-1 inhibitor licensed after hedgehog-inhibitor failure

Cemiplimab is licensed for locally advanced or metastatic basal-cell carcinoma after hedgehog-pathway-inhibitor progression or intolerance. Sonidegib, a second hedgehog inhibitor, after vismodegib progression: switching within hedgehog blockade does not address established pathway-inhibitor progression. Pembrolizumab, a PD-1 inhibitor, after vismodegib progression: checkpoint blockade is biologically plausible, but cemiplimab is the UK-licensed agent in this setting. Cetuximab, an EGFR antibody, after vismodegib progression: EGFR blockade lacks the disease-specific licensed indication. Vismodegib dose escalation after progression on the standard dose: dose escalation is not the evidence-based strategy after hedgehog-inhibitor progression.

Reference: LIBTAYO 350 mg UK summary of product characteristics (Current UK SmPC, updated 2026): https://www.medicines.org.uk/emc/product/10438/smpc; NICE TA489 vismodegib: recommendations (Published November 2017; current NICE TA): https://www.nice.org.uk/guidance/ta489/chapter/1-Recommendations