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With regard to basal cell carcinoma, we're starting to have increasing evidence to support multidisciplinary care, integrating both systemic therapy and radiation therapy, especially for very large or unresectable tumors.”

Matthew P. Deek, MD, radiation oncologist, assistant professor, Division of Clinical Radiation Oncology, Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, discusses the role of multidisciplinary approaches for the treatment of patients with locally advanced unresectable basal cell carcinoma (BCC).

Specifically, he highlights findings from a phase 2 single-arm trial (NCT01835626) evaluating the integration of vismodegib (Erivedge), a hedgehog pathway inhibitor, with curative-intent radiation therapy for this patient population. During the study, patients received 12 weeks of induction therapy consisting of vismodegib monotherapy, following by 7 weeks of concurrent vismodegib and radiotherapy.

Preliminary results demonstrated a locoregional control rate of 91% (95% CI, 68%-98%) at 1 year. The overall response rate was 63% (95% CI, 38%-84%) following induction therapy with vismodegib alone, which improved to 83% (95% CI, 59%-96%) after concurrent vismodegib and radiation therapy. At a median follow-up of 5.7 years, the 1-year progression-free survival (PFS) and overall survival (OS) rates were 100% and 96%, respectively; the respective 5-year PFS and OS rates were 78% and 83%.

For patients with unresectable BCC, a single-modality approach, such as radiotherapy alone, often yields suboptimal results due to the complexity and size of these tumors, Deek explains. This trial demonstrated the feasibility and effectiveness of combining vismodegib with definitive radiation therapy in this patient population, he adds.

This trial and other emerging data highlight the evolving role of systemic therapy and the need for a multidisciplinary approach for patients with locally advanced unresectable BCC, he continues. Tailoring treatment plans to individual patients is key in the management of locally advanced unresectable BCC, he concludes.

Videos

Matthew P. Deek, MD, discusses multidisciplinary approaches in treating locally advanced basal cell carcinoma.

Dr Deek on Vismodegib Plus Radiation in Locally Advanced Unresectable Basal Cell Carcinoma

Matthew Pierre Deek, MD, radiation oncologist, assistant professor, Division of Clinical Radiation Oncology, Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, discusses the significance of pretreatment immune cell infiltration in patients with muscle-invasive bladder cancer (MIBC) who had been treated with definitive chemoradiation.

A retrospective study aimed to evaluate the influence of the tumor immune microenvironment on the outcomes of patients undergoing chemotherapy or radiation therapy for MIBC, Deek begins. To achieve this, investigators retrospectively collected specimens from 2 NRG prospective studies (NRG/RTOG 0712; RTOG 0524) that had been stored in a biobank, he states. Investigators then conducted RNA sequencing on these samples using a novel proprietary method for deconvoluting bulk tumor RNA from tumor samples, Deek emphasizes. Subsequently, investigators performed bioinformatics analyses to assess the immune cell infiltration within the tumor microenvironment of patients who were enrolled in these 2 trials and treated with chemoradiation, he explains.

The investigators’ secondary goal was to comprehend the gene expression patterns that indicated a hot tumor, or a tumor that is predisposed to an active immune response against the cancer, Deek expands. Several noteworthy observations emerged from the analysis. Firstly, when examining the patient population as a whole, a significant variation of immune cell infiltration within the tumor microenvironment was observed, ranging from low levels to high levels of infiltrates, Deek says.

Investigators focused on patients with higher levels of immune cell infiltration, specifically CD8-positive T cells. These patients exhibited significantly better prognoses following chemoradiation than those with lower levels of immune cell infiltration, including improved responses to treatment and enhanced disease control, he continues. Additionally, investigatorsfound that gene expressions associated with a hot tumor, such as interferon gamma, which is indicative of immunological activity, also correlated with improved outcomes after chemoradiation, Deek explains. These findings underscore the significance of immune infiltrates and indicators of immune activation as valuable prognostic factors for predicting a patient's response to chemoradiation therapy for MIBC, he concludes.

Matthew Pierre Deek, MD, discusses the significance of pretreatment immune cell infiltration in patients with muscle-invasive bladder cancer who had been treated with definitive chemoradiation.

Matthew Pierre Deek, MD

Articles

Dr Deek on Vismodegib Plus Radiation in Locally Advanced Unresectable Basal Cell Carcinoma

Dr Deek on the Investigation of Immune Cell Infiltration in MIBC