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Itraconazole for therapy BCC Presentation.pptx
- 1. Itraconazole in theTreatment of Basal Cell Carcinoma Ip KH, McKerrow K. Australas J Dermatol. 2021
- 2. Background: BCC andHedgehog Pathway • BCC is primarily driven by the Hedgehog (Hh) signaling pathway • Vismodegib: first approved Hh pathway inhibitor for advanced BCC • Itraconazole: antifungal agent that inhibits Hh signaling via Smoothened (SMO) binding • Also inhibits angiogenesis and induces cell cycle arrest
- 3. Case Report: PatientProfile • 69-year-old Caucasian male • History of >40 BCCs, largest measuring 16×32 cm on the back • Pulmonary nodules found incidentally via MRI • Lung biopsy confirmed metastatic BCC
- 4. Treatment Strategy • Vismodegibfunding denied • Initiated oral itraconazole 100 mg twice daily • Celecoxib 200 mg twice daily added after 2 years for chemoprevention
- 5. Clinical Outcomes • Atleast 30% tumor reduction on imaging • Largest nodule reduced from 22×21×16 mm to 10×10×5 mm over 23 months • Stable disease for 49 months • No adverse effects or liver enzyme changes reported
- 6. Systematic Review: Methodology •MEDLINE and EMBASE searched (Feb 12, 2021) • Keywords: 'basal cell carcinoma', 'itraconazole' • 9 studies included, total 42 patients • Analysis of clinical outcomes for itraconazole in BCC
- 7. Review Findings: Monotherapy •10 patients treated with oral itraconazole alone • Doses ranged from 100 mg daily to 200 mg twice daily • 57 primary BCCs: mean area reduction 24% • One patient had no response; another showed slight improvement
- 8. Review Findings: Topicaland Combination Therapies • Topical 0.7% itraconazole gel: no significant tumor size reduction • Combined therapies: Itraconazole + vismodegib Itraconazole + sonidegib Itraconazole + arsenic trioxide • Some cases showed clinical resolution or disease stability
- 9. Adverse Effects • Monotherapy:minimal side effects • Combination therapy: fatigue, heart failure, dysgeusia, alopecia • One patient had dose-related dyspnea and abdominal pain
- 10. Discussion and Significance •First reported monotherapy success in metastatic BCC • Longest itraconazole treatment and follow-up (49 months) • Celecoxib role unlikely related to tumor response • Supports itraconazole's cost-effective and tolerable profile
- 11. Conclusion • Promising alternativewhen standard Hh inhibitors are unavailable or ineffective • Evidence from case reports and small studies • Larger clinical trials are needed to define its therapeutic role
- 12. References • - Kimet al., JCO 2014 • - Ciazynska et al., JCO Oncol. Practice 2020 • - Ally et al., JAMA Dermatol 2016 • - Sohn et al., JAMA Dermatol 2019 • - Full citations available in original manuscript