Survey of the impact of BOLT-trial data on oncologists’ and dermatologists’ decision-making in treating patients with locally advanced basal cell carcinoma

Basal cell carcinoma (BCC) is the most common malignant tumor in white populations. Multiple studies demonstrated that the aberrant activation of Hedgehog signaling is a driver of BCC development, and its blockade represents a potential therapeutic target. In Italy, clinicians can prescribe Hedgehog inhibitors (HhIs) vismodegib and sonidegib. To highlight the treatment choice of clinicians, we conducted an online survey between November 1 and November 18, 2020, with 33 Italian clinicians from 27 reference hospitals, in which each participant received an anonymous survey consisting of two multiple-choice questions on the clinical efficacy and safety profile of sonidegib and vismodegib. Respondents reported their opinions on which efficacy and tolerability data of the pivotal phase-II BOLT trial were more relevant in patients’ treatment choices with locally advanced BCC (laBCC). This survey shows that the overall response rate (ORR) and the duration of response (DoR) are the most expected across dermatologists and oncologists. The different pharmacokinetic profiles of the two HhIs are behind their diverse toxicity spectrum; dose and schedule modification seem to address the choice between vismodegib and sonidegib among dermato-oncology prescribers.