Advanced BCC: histological subtype and time to complete response may predict tumour recurrence

The likelihood of relapse in patients with advanced basal cell carcinoma (BCC) treated with hedgehog pathway inhibitors (HHI) may be influenced by 2 factors: the histologic risk status at diagnosis and the time required to achieve complete remission (CR). Data from a retrospective analysis found that patients with low-risk histology and those who reached CR within 8 months demonstrated a lower propensity for relapse.

Hedgehog pathway inhibition with vismodegib or sonidegib is the suggested treatment for patients with locally advanced and metastatic BCC, as curative surgery or radiotherapy is not to be expected [1,2]. A retrospective multicentre study investigated patients with advanced BCC treated with HHI for factors linked to recurrence after CR [1]. Between 2016 and 2024, Dr Maria Mannino (Catholic University of the Sacred Heart, Italy) and colleagues enrolled 106 adult participants who had received HHIs sonidegib (88.7%) or vismodegib (11.3%). The cohort’s mean age was 78 years, 35.8% were women, and the median duration of HHI therapy was 18 months. CR was achieved after a median of 8 months and 68.9% of participants received HHI treatment beyond CR.

A BCC relapse after CR happened in 13.2% of participants at a median of 12 months. The overall likelihood of relapse-free survival was 77.8%. High-risk histological subtypes (e.g. morpheiform, basosquamous, infiltrative, and micronodular) were more prevalent in the tumour recurrence arm versus the non-relapsing participants (71.4% vs 28.3%). Consistent with this, further analyses identified that having a low-risk subtype in the histology of BCC was linked to a better chance of relapse-free survival with an odds ratio (OR) of 0.15 (95% CI 0.04–0.51; P=0.003) compared with a high-risk histology.

In addition, time to CR significantly influenced the risk of relapse (OR 1.07; 95% CI 1.01–1.15; P=0.04). Specifically, reaching CR in 8 months or less entailed a significantly higher probability of relapse-free survival (HR 0.14; 95% CI 0.047–0.43; P=0.0003).

All in all, this study identified histological risk features and time to CR as possible predictors of tumour recurrence after CR in advanced BCC. These findings may influence treatment decisions and follow-up strategies for patients with advanced BBC, receiving HHI therapy.

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   1. Mannino M. Advanced basal cell carcinoma: clinical and histological predictors of tumor recurrence after complete response on hedgehog inhibitors. EPS02.02, EADV Congress 2024, 25–28 September, Amsterdam, the Netherlands.
   2. Peris K, et al. Eur J Cancer 2019:118:10-34.

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Posted on 6 November 20246 November 2024