{'fraction_non_alphanumeric': 0.041576673866090715, 'fraction_numerical': 0.02267818574514039, 'mean_word_length': 5.197324414715719, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Drug‐related adverse effects of vismodegib and sonidegib for locally advanced or metastatic basal cell carcinoma

The hedgehog signalling pathway inhibitors vismodegib and sonidegib are effective in patients with locally advanced basal cell carcinoma (laBCC) and metastatic basal cell carcinoma (mBCC). However, drug-related side effects are common and present barriers to compliance. In the long-term safety and efficacy ERIVANCE study of vismodegib 150mg daily, 100% of participants experienced at least one treatment-emergent adverse event (TEAE), most commonly muscle spasms (71%), alopecia (66%), dysgeusia (56%) or weight loss (52%). TEAEs led to treatment discontinuation in 21% of participants. In the long-term safety and efficacy BOLT study of sonidegib 200mg daily, the most commonly reported TEAEs were muscle spasms (54%), alopecia (49%), dysgeusia (44%) and nausea (39%). TEAEs led to treatment discontinuation in 30% of participants. Both vismodegib and sonidegib are subsidised by the pharmaceutical benefits scheme (PBS) for patients with laBCC or mBCC inappropriate for surgery or curative radiotherapy. Patients who cannot tolerate one agent may receive subsidised access to the other. Here, we present two cases of patients with laBCC who were unable to tolerate vismodegib due to TEAEs. The first patient is a 74-year-old gentleman with multiple laBCCs on the scalp who was irradiated for acne as a teenager (Fig. 1). He had previously been treated unsuccessfully with surgery and radiotherapy. His laBCCs resolved within 3 months of treatment with vismodegib 150mg daily. However, he ceased this due to debilitating leg cramps and dysgeusia. These symptoms resolved within 3 months of ceasing vismodegib. However, his scalp laBCCs recurred. He then commenced sonidegib 200mg daily. After 6 months, his laBCCs improved (Fig. 2). He