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Basal cell carcinoma (BCC) is highly curable by surgical excision or radiation. In rare cases, BCC can be locally destructive or difficult to surgically remove. Hedgehog inhibition (HHI) with vismodegib or sonidegib induces a 50–60% response rate. Long-term toxicity includes muscle spasms and weight loss leading to dose decreases. This retrospective chart review also investigates the impact of CoQ10 and calcium supplementation in patients treated with HHI drugs at a single academic medical center from 2012 to 2022. We reviewed the charts of adult patients diagnosed with locally advanced or metastatic BCC treated with vismodegib or sonidegib primarily for progression-free survival (PFS). Secondary objectives included overall survival, BCC-specific survival, time to and reasons for discontinuation, overall response rate, safety and tolerability, use of CoQ10 and calcium supplements, and insurance coverage. Of 55 patients assessable for outcome, 34 (61.8%) had an overall clinical benefit, with 25 (45.4%) having a complete response and 9 (16.3%) a partial response. Stable disease was seen in 14 (25.4%) and 7 (12.7%) progressed. Of the 34 patients who responded to treatment, 9 recurred. Patients who were rechallenged with HHI could respond again. The median overall BCC-specific survival rate at 5 years is 89%. Dose reductions or discontinuations for vismodegib and sonidegib occurred in 59% versus 24% of cases, or 30% versus 9% of cases, respectively. With CoQ10 and calcium supplementation, only 17% required a dose reduction versus 42% without. HHI is highly effective for treating advanced BCC but may require dosing decreases. Sonidegib was better tolerated than vismodegib. CoQ10 and calcium supplementation can effectively prevent muscle spasms. [ABSTRACT FROM AUTHOR]

BACKGROUND: Prophylaxis against infection after a hematopoietic stem-cell transplant (HSCT) is a standard of care requiring a variety of anti-infective agents. In November 2017, letermovir was approved for cytomegalovirus (CMV) infection or disease prophylaxis in CMV-seropositive adults who had undergone an allogeneic HSCT. In January 2018, letermovir was added to the Karmanos Cancer Center’s Detroit, MI, formulary, to be used in high-risk allogeneic HSCT recipients, starting on day 10 post-transplant through day 100 post-transplant. OBJECTIVE: To evaluate the rates of CMV infection at week 24 before and after the implementation of CMV prophylaxis with letermovir in high-risk HSCT recipients who are CMV-seropositive or CMVseronegative with a CMV-seropositive stem-cell donor. METHODS: We conducted a retrospective chart review at Karmanos Cancer Center to assess the efficacy of letermovir for CMV prophylaxis in allogeneic HSCT recipients. The study eligibility criteria included age ≥18 years, post–allogeneic HSCT status, and CMV-seropositive recipient or CMVseronegative recipient with a CMV-seropositive donor. The patients were divided into 2 cohorts: a historical control group and a letermovir-recipient group. The historical control group included patients who had undergone an allogeneic HSCT between March 1, 2017, and February 28, 2018, and therefore did not receive CMV prophylaxis with letermovir. The letermovir group included patients who had an allogeneic HSCT after the approval of letermovir and received CMV prophylaxis with letermovir postHSCT between March 1, 2018, and February 28, 2019, based on the institutional standard of care. RESULTS: The final analysis included 128 patients, with 67 patients in the control group and 61 patients in the letermovir group. In the control group, 36 (54%) patients had a CMV infection compared with 6 (10%) patients in the letermovir group (P <.001). Of the patients who had CMV infection, 4 patients in the control group had documented CMV disease compared with none of the patients in the letermovir group (P = .046). The time to undetectable CMV by polymerase chain reaction (PCR) test was significantly shorter in the letermovir group than in the control group (16 days vs 29 days, respectively; P = .016). CONCLUSION: These results show that CMV prophylaxis with letermovir was effective in preventing and delaying CMV infection and resulted in a quicker clearance of CMV per serum PCR in post– allogeneic HSCT recipients who were CMV-seropositive or received stem cells from a CMVseropositive donor. [ABSTRACT FROM AUTHOR]