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Advanced BCC Hedgehog — SCE Medical Oncology MCQ

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ModerateMelanoma & SkinAdvanced BCC HedgehogSCE Medical Oncology

A 60-year-old man with advanced basal cell carcinoma (locally advanced, not amenable to surgery or RT) asks about systemic therapy. What is available?

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Correct answer: B — Hedgehog pathway inhibitors (vismodegib, sonidegib) — BCCs are driven by aberrant Hedgehog signalling (PTCH1/SMO mutations); vismodegib achieves ~30-43% ORR in advanced BCC; for Hedgehog inhibitor-resistant BCC, cemiplimab (anti-PD-1) is an option

BCC: nearly all driven by Hedgehog pathway activation (PTCH1 loss/SMO gain-of-function). Vismodegib (NICE TA489)/sonidegib: first-line for locally advanced/metastatic BCC. Common toxicity: muscle spasms, alopecia, dysgeusia, weight loss. Cemiplimab (anti-PD-1): option for Hedgehog inhibitor-resistant/intolerant BCC.

Reference: NICE TA489; ERIVANCE; ESMO Non-melanoma Skin Cancer