SKIN 
 

March 2019     Volume 3  Issue 2 
 

Copyright 2018 The National Society for Cutaneous Medicine 150 

RISING DERM STARS® 
 

 
Long Term Outcomes for Basal Cell Carcinoma Treated with Vismodegib 
Extended Alternate Day Dosing 
 
Ethan Routt, MD1; Desiree Ratner MD 
 
1Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 
 

 
 
Background/Objectives: Management of 
locally advanced basal cell carcinoma (BCC) 
has change dramatically since the 
introduction of vismodegib, a hedgehog 
pathway inhibitor. While response rates to 
vismodegib exceeds 30%, nearly 100% of 
patients on standard dosing experience side 
effects with many patients discontinuing 
therapy as a result. Alternative dosing 
regimens have been proposed to increase 
the therapeutic longevity of vismodegib and 
we report a novel extended alternate day 
(EAD) dosing for this medication. 
 
Methods: IRB approved retrospective chart 
review including all locally advanced BCC 
patients treated by Dr. Ratner with 
vismodegib between 1/2015 and 5/2018. All 
clinical data, including patient and tumor 
characteristics, patient outcomes, 
vismodegib dosing schedule and tumor 
response was extracted from the electronic 
medical record, compiled and analyzed in 
Microsoft Excel. All dosing listed indicates 
vismodegib 150 mg taken either daily (FDA 
approved) or on a variable alternate day 
schedule. 
 
Results: Nine total patients were identified, 
one treated with daily dosing and 8 treated 
with EAD dosing. Mean patient age was 84 
years with a mean duration of vismodegib 
therapy of 255 days. Six patients went on 

every other day dosing for a mean of 125 
days, every third day dosing for 94 days and 
up to weekly dosing depending on patient 
and tumor response. Three patients 
underwent Mohs micrographic surgery 
(MMS) while on EAD dosing and 4 remained 
on therapy at the end of the study period. 
None of the patients on EAD dosing 
discontinued due to side effects and all 
maintained tumor response (mean 50% 
reduction in length and width) to medication 
during the follow up period. 
 
Discussion: Extended alternate day therapy 
provided effective tumor control over a mean 
of 8.5 months for seven of the nine patients. 
All patients on EAD dosing experienced a 
decrease in tumor size, with none exhibiting 
tumor progression on EAD dosing. While a 
smaller sample size, this is a significant 
improvement over previously reported 
outcomes for vismodegib therapy. One 
patient who discontinued his every five-day 
vismodegib dosing due to hospitalization did 
have tumor regrowth, but after resuming 
therapy with EAD dosing, experienced a 
continued reduction in tumor size. Four of 
nine patients under went MMS after starting 
EAD dosing indicating that this schedule may 
be an effective in those who are unable to 
tolerate standard vismodegib dosing as a 
neoadjuvant to MMS. 
 



SKIN 
 

March 2019     Volume 3  Issue 2 
 

Copyright 2018 The National Society for Cutaneous Medicine 151 

 
Conclusion: EAD dosing provided a 
titratable, well tolerated regimen for 
vismodegib therapy that maintained efficacy 
over eight months or more.  Clinicians should 
consider EAD dosing for patients who 
respond to vismodegib but are unable to 
tolerate its side effects. Further study will help 
determine whether EAD dosing might extend 
vismodegib’s utility, providing an option of 
lower dose, long-term suppressive therapy 
for BCC patients unable to tolerate surgery or 
radiation.