Evaluation of the Tolerability of Hedgehog Pathway Inhibitors in the Treatment of Advanced Basal Cell Carcinoma: A Narrative Review of Treatment Strategies

Hedgehog pathway inhibitors (HHIs), specifically sonidegib and vismodegib, have expanded treatment options for advanced basal cell carcinoma (BCC) but are associated with adverse events (AEs) such as muscle spasms, creatine phosphokinase increase, alopecia, and dysgeusia. These AEs often occur early in treatment and can lead to discontinuation, impacting clinical outcomes. Differences in pharmacokinetics between the two drugs may affect the timing and resolution of AEs. Effective management strategies, including treatment interruptions, dose reductions, and both nonpharmacologic and pharmacologic interventions, can help manage AEs while maintaining disease control. Awareness and planning are crucial for healthcare providers and patients to optimize therapeutic responses and avoid discontinuation.