They work to decrease phosphorylation of smoothened. And then one newer agent being investigated is targeted to casein kinase 2, and casein kinase 2 targeted agents work in 3 different areas. For squamous cell carcinoma, there are epidermal growth factor receptor inhibitors, and there are multiple of them.
There are newer agents coming, and we could discuss that. Migden, MD:Right, as you said, for basal cell carcinoma, there are Hedgehog inhibitors, which to date have been primarily focused on smoothened inhibitors. Could you comment on what targeted therapy has been employed in clinical trials, what has been successful, and what are we looking for down the line? What changes, somatic mutations, are found? Is there something like EGFR? In basal cell, we know Hedgehog inhibitors work very well. Shubham Pant, MD:I’ll come to that, but tell me a little bit about what kind of targets can you find. But there’s not been one standard, and there’s really never been until recently an FDA approved treatment, a systemic therapy, and that’s changed recently. There have been epidermal growth factor receptor targeted agents. There’s been chemotherapy such as platinum agents. Migden, MD:The history of treatment for locally advanced or metastatic squamous cell carcinoma has been that there’s no one standard of therapy. Shubham Pant, MD:What are the primary treatment options for locally advanced or metastatic squamous cell carcinoma? That would be, for example, superficial basal cell carcinoma. Some of these can be treated, if they’re extremely thin, with topical agents such as imiquimod. It could be, if it’s a smaller lesion, destruction with curettage and either electrodesiccation or cryotherapy. Migden, MD:In basal cell carcinoma, and it’s pretty much the same for squamous cell carcinoma, 95%-plus of the tumors are treated with a local therapy that could be surgery, such as Mohs surgery or excision. Shubham Pant, MD:When you see a patient who has advanced or metastatic basal cell or squamous cell carcinoma, and I’ll go with basal cell first, what are the treatment options for these patients?
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