The purpose of this study is to learn about the effect of vismodegib on sporadic basal cell carcinoma (BCCs) prior to surgical removal.

PRIMARY OBJECTIVES:

I. The percent reduction in surgical defect area/size surrounding BCC tumor pre and post-vismodegib.

SECONDARY OBJECTIVES:

I. Recurrence rate post treatment II. Safety, tolerability and percent drop-out after 3 vs. 6 months of vismodegib in otherwise healthy patients.

OUTLINE:

Patients receive vismodegib orally (PO) once daily (QD) for up to 3 months if the initial BCC size is < 2 cm and superficial or for up to 6 months if the initial BCC size is >= 2 cm or non-superficial. After completion of vismodegib treatment, patients undergo Mohs surgery.

After completion of study treatment, patients are followed up for an average of 24 months.

Inclusion Criteria:

• Study patients must have at least one BCC, > 5 mm, eligible for Mohs surgical removal; patients with BCCs that have been treated before (recurrent BCCs, BCCs that failed other chemotherapy) are eligible for this trial, if they meet size criteria
• No Eastern Cooperative Oncology Group (ECOG) or Karnofsky performance status will be employed
• Normal hepatic function: aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 2 x the upper limit of normal (ULN)
• Normal renal function : normal serum creatinine defined as <= 2.5 mg/dL
• Clinically acceptable complete blood count (CBC)
• Ability to understand and the willingness to sign a written informed consent document
• The patient is willing to forego surgical treatment of BCCs by up to 6 months, except when the principal investigator (PI) believes that delay in treatment potentially might compromise the health of the subject
• Documented negative serum pregnancy test for women of childbearing potential, with agreement to the use of two acceptable methods of contraception during the study and for 7 months after discontinuation of vismodegib
• For men with female partners of childbearing potential, agreement to use a latex, non-latex, or any other male condom and to advise their female partners to use an additional acceptable method of birth control during the study and for 2 months after discontinuation of study drug
• Be willing to not donate blood or semen for three months following discontinuation of study medications

Exclusion Criteria:

• The patient has a history of invasive cancer within the past five years excluding non-melanoma skin cancer, stage I cervical cancer, ductal carcinoma in situ of the breast, or chronic lymphocytic leukemia (CLL) stage 0

• The subject has uncontrolled systemic disease, including known human immunodeficiency virus (HIV) positive patients:

  • The patient has history of congestive heart failure
  • The patient has clinically important history of liver disease, including viral or hepatitis, current alcohol abuse, or cirrhosis
  • The patient has any condition or situation which in the investigator's opinion may put the patient at significant risk, could confound the study results, or could interfere significantly with the subject's participation in the study; this includes history of other skin conditions or disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates use of an investigational drug or that might affect interpretation of the results of the study or render the patient at high risk from treatment complications

• The patient has a history of hypersensitivity to any of the ingredients in the study medication formulations

• The patient is willing to abstain from application of non-study topical medications to the skin for the duration of the study, including prescription and over the counter preparations; for example, topical preparations containing corticosteroids or vitamin A derivatives are not allowed

• Pregnant or nursing patients will be excluded from the study

We enrolled patients with at least 1 biopsy-confirmed BCC of any histologic subtype, more than 5 mm in diameter, eligible for surgical removal. Only patients who were treated with vismodegib for an average of 4 months were included in our analysis.

An average of 24 months

We evaluated patients monthly for skin examinations and adverse events (National Cancer Institute Common Terminology Criteria for Adverse Events, Version 4).