Guidelines for vismodegib in the management of periocular basal cell carcinoma

The management of advanced basal cell carcinoma (BCC) in the periocular region remains a clinical challenge. Vismodegib (ErivedgeTM) has been approved in 2013 by Health Canada for adult patients with “histologically confirmed metastatic BCC or locally advanced BCC inappropriate for surgery or radiation.” An expert consensus was sought to create a standardised approach in the use of this novel treatment. Fourteen practicing oculoplastic surgeons across Canada were involved in formulating and reviewing guidelines until consensus was reached. A consultancy meeting was followed by further ratification of guidelines over email. Two voting surveys were performed of the group to objectively assess agreement over each statement within the guidelines. Ratification continued until at least two-thirds of the group agreed on every guideline statement. The guidelines summarize 21 statements in a major and minor criteria format. A multidisciplinary team review is suggested for each patient with the involvement of recommended specialists. The internal survey revealed 100% agreement over 9 statements, 91.7% agreement over 8 statements, 83.3% agreement over 4 statements, and 2 statements had 66.7% and 58.7% agreement each. All statements with less than 91.7% agreement were surveyed again, and they were kept, modified, or removed on the basis of a consensus of over 66.7%. These guidelines serve to act as a framework for physicians considering vismodegib for the medical management of patients with advanced or metastatic periocular BCC. Future applications, including neoadjuvant uses of the drug, may become apparent through further research. La prise en charge du carcinome basocellulaire avancé de la région périoculaire demeure un défi clinique. Santé Canada a approuvé le vismodegib (Erivedge®) en 2013 « dans le traitement des adultes atteints d'un carcinome basocellulaire (CBC) métastatique ou d'un CBC localement avancé, confirmés par examen histologique, quand une intervention chirurgicale ou une radiothérapie ne sont pas appropriées ». Un groupe d'experts a été mis sur pied afin d’établir une démarche standardisée quant à l'utilisation de ce traitement novateur. Ainsi, 14 chirurgiens oculoplasticiens en exercice au Canada ont pris part à l’établissement et à l'examen de lignes directrices jusqu’à l'obtention d'un consensus. Une rencontre de consultation a permis de procéder à une ratification supplémentaire des lignes directrices par courriel. Deux sondages réalisés en vue