Abstract: PO2225
Renal Transplant Recipient with Large Periorbital Basal Cell Carcinoma (BCC) Cured Nonsurgically with Vismodegib
Session Information
- Transplantation: Clinical - Noninvasive Biomarkers, Immune Regulation, and Fascinomas
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Varela, Daniel, The University of Texas Rio Grande Valley, Edinburg, Texas, United States
- Rocha, Desika, DHR Health, Edinburg, Texas, United States
- Trevino Manllo, Sergio A., DHR Health, Edinburg, Texas, United States
- Alsabbagh, Mourad, DHR Health, Edinburg, Texas, United States
Introduction
Renal transplant recipients (RTR) live a delicate balance between preserving allograft function with immunosuppression medications (IS) and the side effects (e.g malignancies), Skin cancers are prevalent with Squamous (SCC) & BCC (SCC), comprising 90% of skin cancers. These tumors are aggressive, exhibiting unique pathophysiologic characteristics. We present a case of a RTR who developed invasive periorbital BCC; successfully treated with novel chemotherapeutic Vismodegib
Case Description
A 66-year-old man with history of kidney transplant had a stable graft function with Cr 1.6 on IS for 35 years, on Prednisone and Tacrolimus. with a history of recurrent SCC and BCC treated with surgical and radiation therapy, During clinic, he was found to have a large tumor in the lateral canthus of the left eye. Patient was referred to dermatology, biopsy evealed BCC. Tumor grew rapidly, further invading the eye within a few weeks. Given the proximity to visual organs; ENT, Ophthalmology, Dermatology, and Transplant team decided to treat the BCC non-surgically with Vismodegib. Patient achieved complete remission in 6 months of treatment with successful preservation of eyesight.
Discussion
Surgical excision is considered first line therapy in BCC. Patients with periocular BCC can place visual organs at risk with surgical and/or radiotherapy. Vismedogib is indicated for metastatic BCC or locally advanced BCC that has recurred following surgery. Vismedogib binds and inhibits the smoothened receptor, leading to hedgehog signaling pathway inhibition and decreased tumor cell proliferation.
Recent studies assessing Vismodegib benefit recruited patients with median tumor size of 22mm. Our case highlights that Vismedogib is efficacious in preserving essential visual structures and eyesight even in much larger tumor burden; 55mm.
In conclusion, Vismodegib is now emerging in critical management of large and fast growing BCC affecting vital facial structures, especially in RTR on long term IS meds.