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Vismodegib in Treating Patients With Basal Cell Carcinoma (BCC)

Primary Purpose

Basal Cell Carcinoma of the Skin, Recurrent Skin Cancer

Status
Completed
Phase
Early Phase 1
Locations
United States
Study Type
Interventional
Intervention
vismodegib
Mohs surgery
Sponsored by
Stanford University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Basal Cell Carcinoma of the Skin

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Study patients must have at least one BCC, > 5 mm, eligible for Mohs surgical removal; patients with BCCs that have been treated before (recurrent BCCs, BCCs that failed other chemotherapy) are eligible for this trial, if they meet size criteria
  • No Eastern Cooperative Oncology Group (ECOG) or Karnofsky performance status will be employed
  • Normal hepatic function: aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 2 x the upper limit of normal (ULN)
  • Normal renal function : normal serum creatinine defined as <= 2.5 mg/dL
  • Clinically acceptable complete blood count (CBC)
  • Ability to understand and the willingness to sign a written informed consent document
  • The patient is willing to forego surgical treatment of BCCs by up to 6 months, except when the principal investigator (PI) believes that delay in treatment potentially might compromise the health of the subject
  • Documented negative serum pregnancy test for women of childbearing potential, with agreement to the use of two acceptable methods of contraception during the study and for 7 months after discontinuation of vismodegib
  • For men with female partners of childbearing potential, agreement to use a latex, non-latex, or any other male condom and to advise their female partners to use an additional acceptable method of birth control during the study and for 2 months after discontinuation of study drug
  • Be willing to not donate blood or semen for three months following discontinuation of study medications

Exclusion Criteria:

  • The patient has a history of invasive cancer within the past five years excluding non-melanoma skin cancer, stage I cervical cancer, ductal carcinoma in situ of the breast, or chronic lymphocytic leukemia (CLL) stage 0
  • The subject has uncontrolled systemic disease, including known human immunodeficiency virus (HIV) positive patients:

    • The patient has history of congestive heart failure
    • The patient has clinically important history of liver disease, including viral or hepatitis, current alcohol abuse, or cirrhosis
    • The patient has any condition or situation which in the investigator's opinion may put the patient at significant risk, could confound the study results, or could interfere significantly with the subject's participation in the study; this includes history of other skin conditions or disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates use of an investigational drug or that might affect interpretation of the results of the study or render the patient at high risk from treatment complications
  • The patient has a history of hypersensitivity to any of the ingredients in the study medication formulations
  • The patient is willing to abstain from application of non-study topical medications to the skin for the duration of the study, including prescription and over the counter preparations; for example, topical preparations containing corticosteroids or vitamin A derivatives are not allowed
  • Pregnant or nursing patients will be excluded from the study

Sites / Locations

  • Stanford University

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment (vismodegib and Mohs surgery)

Arm Description

Patients receive vismodegib PO daily for 3-6 months based on the size of basal cell carcinoma and then undergo Mohs surgery.

Outcomes

Primary Outcome Measures

Percent Change in Surgical Defect Area After the Treatment Period Using Calipers and Photographs Was Calculated
At baseline, we selected 1 to 2 tumors per patient for surgery (13 target tumors selected). At baseline,1 Mohs surgeon measured the estimated surgical defect area around the target tumor. For tumors to be excised by Mohs we defined estimated surgical defect as the tumor size plus a 2-mm circumferential margin, presuming tumor clearance after a Mohs stage-1 excision. For the tumor undergoing standard (non-Mohs) excision, we used tumor size plus a standard 4-mm margin11 for the estimated surgical defect. On the day of the surgery, we measured the surgical defect area as the final tumor-free defect after the Mohs procedure or non-Mohs excision immediately before closure. We used the Image J software program (National Institutes of Health, Bethesda, MD) to calculate tumor area (cm2). Only target tumors are included in this analysis.

Secondary Outcome Measures

Number of Tumors Demonstrating Histologic Cure
Determination of histologic cure (no residual BCC on the first piece of excised tissue) post serial sectioning of paraffin embedded Mohs specimens
Tumor Recurrence Rate of Treated BCCs
Recurrence rate of BCCs during a 22 month average (range 12 to 28 months) follow up period.
Tumor Size Measurements Before and After Short Term Vismodegib Treatment
We measured the length and width of all tumors (target and non-target) before and after vismodegib treatment.

Full Information

First Posted
June 25, 2012
Last Updated
November 6, 2017
Sponsor
Stanford University
Collaborators
National Cancer Institute (NCI), University Hospitals Cleveland Medical Center
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1. Study Identification

Unique Protocol Identification Number
NCT01631331
Brief Title
Vismodegib in Treating Patients With Basal Cell Carcinoma (BCC)
Official Title
A Pilot Study to Investigate the Off Label Use of Vismodegib as an Adjuvant to Surgery for Basal Cell Carcinoma Tumors (BCCs)
Study Type
Interventional

2. Study Status

Record Verification Date
August 2017
Overall Recruitment Status
Completed
Study Start Date
June 2012 (undefined)
Primary Completion Date
September 17, 2015 (Actual)
Study Completion Date
May 31, 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Stanford University
Collaborators
National Cancer Institute (NCI), University Hospitals Cleveland Medical Center

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to learn about the effect of vismodegib on sporadic basal cell carcinoma (BCCs) prior to surgical removal.
Detailed Description
PRIMARY OBJECTIVES: I. The percent reduction in surgical defect area/size surrounding BCC tumor pre and post-vismodegib. SECONDARY OBJECTIVES: I. Recurrence rate post treatment II. Safety, tolerability and percent drop-out after 3 vs. 6 months of vismodegib in otherwise healthy patients. OUTLINE: Patients receive vismodegib orally (PO) once daily (QD) for up to 3 months if the initial BCC size is < 2 cm and superficial or for up to 6 months if the initial BCC size is >= 2 cm or non-superficial. After completion of vismodegib treatment, patients undergo Mohs surgery. After completion of study treatment, patients are followed up for an average of 24 months.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Basal Cell Carcinoma of the Skin, Recurrent Skin Cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Early Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
15 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Treatment (vismodegib and Mohs surgery)
Arm Type
Experimental
Arm Description
Patients receive vismodegib PO daily for 3-6 months based on the size of basal cell carcinoma and then undergo Mohs surgery.
Intervention Type
Drug
Intervention Name(s)
vismodegib
Other Intervention Name(s)
Erivedge, GDC-0449, Hedgehog antagonist GDC-0449
Intervention Description
Given PO
Intervention Type
Procedure
Intervention Name(s)
Mohs surgery
Intervention Description
Undergo Mohs surgery
Primary Outcome Measure Information:
Title
Percent Change in Surgical Defect Area After the Treatment Period Using Calipers and Photographs Was Calculated
Description
At baseline, we selected 1 to 2 tumors per patient for surgery (13 target tumors selected). At baseline,1 Mohs surgeon measured the estimated surgical defect area around the target tumor. For tumors to be excised by Mohs we defined estimated surgical defect as the tumor size plus a 2-mm circumferential margin, presuming tumor clearance after a Mohs stage-1 excision. For the tumor undergoing standard (non-Mohs) excision, we used tumor size plus a standard 4-mm margin11 for the estimated surgical defect. On the day of the surgery, we measured the surgical defect area as the final tumor-free defect after the Mohs procedure or non-Mohs excision immediately before closure. We used the Image J software program (National Institutes of Health, Bethesda, MD) to calculate tumor area (cm2). Only target tumors are included in this analysis.
Time Frame
average of 4 months
Secondary Outcome Measure Information:
Title
Number of Tumors Demonstrating Histologic Cure
Description
Determination of histologic cure (no residual BCC on the first piece of excised tissue) post serial sectioning of paraffin embedded Mohs specimens
Time Frame
Average of 4 months
Title
Tumor Recurrence Rate of Treated BCCs
Description
Recurrence rate of BCCs during a 22 month average (range 12 to 28 months) follow up period.
Time Frame
average of 22 months
Title
Tumor Size Measurements Before and After Short Term Vismodegib Treatment
Description
We measured the length and width of all tumors (target and non-target) before and after vismodegib treatment.
Time Frame
4 months (average)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Study patients must have at least one BCC, > 5 mm, eligible for Mohs surgical removal; patients with BCCs that have been treated before (recurrent BCCs, BCCs that failed other chemotherapy) are eligible for this trial, if they meet size criteria No Eastern Cooperative Oncology Group (ECOG) or Karnofsky performance status will be employed Normal hepatic function: aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 2 x the upper limit of normal (ULN) Normal renal function : normal serum creatinine defined as <= 2.5 mg/dL Clinically acceptable complete blood count (CBC) Ability to understand and the willingness to sign a written informed consent document The patient is willing to forego surgical treatment of BCCs by up to 6 months, except when the principal investigator (PI) believes that delay in treatment potentially might compromise the health of the subject Documented negative serum pregnancy test for women of childbearing potential, with agreement to the use of two acceptable methods of contraception during the study and for 7 months after discontinuation of vismodegib For men with female partners of childbearing potential, agreement to use a latex, non-latex, or any other male condom and to advise their female partners to use an additional acceptable method of birth control during the study and for 2 months after discontinuation of study drug Be willing to not donate blood or semen for three months following discontinuation of study medications Exclusion Criteria: The patient has a history of invasive cancer within the past five years excluding non-melanoma skin cancer, stage I cervical cancer, ductal carcinoma in situ of the breast, or chronic lymphocytic leukemia (CLL) stage 0 The subject has uncontrolled systemic disease, including known human immunodeficiency virus (HIV) positive patients: The patient has history of congestive heart failure The patient has clinically important history of liver disease, including viral or hepatitis, current alcohol abuse, or cirrhosis The patient has any condition or situation which in the investigator's opinion may put the patient at significant risk, could confound the study results, or could interfere significantly with the subject's participation in the study; this includes history of other skin conditions or disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates use of an investigational drug or that might affect interpretation of the results of the study or render the patient at high risk from treatment complications The patient has a history of hypersensitivity to any of the ingredients in the study medication formulations The patient is willing to abstain from application of non-study topical medications to the skin for the duration of the study, including prescription and over the counter preparations; for example, topical preparations containing corticosteroids or vitamin A derivatives are not allowed Pregnant or nursing patients will be excluded from the study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jean Tang
Organizational Affiliation
Stanford University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Stanford University
City
Stanford
State/Province
California
ZIP/Postal Code
94305
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
24929884
Citation
Ally MS, Aasi S, Wysong A, Teng C, Anderson E, Bailey-Healy I, Oro A, Kim J, Chang AL, Tang JY. An investigator-initiated open-label clinical trial of vismodegib as a neoadjuvant to surgery for high-risk basal cell carcinoma. J Am Acad Dermatol. 2014 Nov;71(5):904-911.e1. doi: 10.1016/j.jaad.2014.05.020. Epub 2014 Jun 11.
Results Reference
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Vismodegib in Treating Patients With Basal Cell Carcinoma (BCC)

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