Targeted Therapy for Advanced Basal-Cell Carcinoma: Vismodegib and Beyond

Basal-cell carcinoma is a commonly occurring skin malignancy that has the potential to progress into locally invasive or resistant disease, as well as spread distantly. Due to advances in the molecular understanding of the disease over the last two decades, it has been discovered that the Hedgehog pathway plays an important role in the pathogenesis of this disease and can be exploited as a treatment target. Several agents that inhibit the Hedgehog pathway have reached clinical studies and one drug, vismodegib, has recently been US Food and Drug Administration (FDA) approved based on clinical activity and tolerability in patients with advanced basal-cell carcinoma. This review will describe the clinical development of vismodegib, as well as the proper application of the drug in clinical practice. Other important clinical questions, such as mechanisms of resistance to vismodegib and the role of other Hedgehog pathway inhibitors currently in development will also be discussed.