RALEIGH, N.C. – The prognosis for patients with metastatic basal cell carcinoma may be better than previous reports have suggested, according to Christina Danial.
A single-center case series found a median overall survival of 7.8 years from diagnosis of BCC metastasis to all-cause mortality, which was significantly better than the 10- to 14-month overall survival described in meta-analyses of roughly 300 case reports of metastatic BCC published since the 1890s, noted Ms. Danial, a medical student at Stanford (Calif.) University.
The Stanford series involved 17 patients with metastatic BCC treated there from 1998 to 2011. Although 17 patients may not sound like a lot, it is in fact the largest single-center experience ever reported – a fact that’s testimony to the rarity of metastatic BCC. The BCC metastasis rate has been estimated at 0.003%-0.55%, Ms. Danial said.
The mean overall survival from the date of diagnosis of the primary tumor to death from any cause was 15.96 years. The mean progression-free survival from diagnosis of the metastasis to disease progression based on physician assessment or radiologic findings was 2.4 years.
The most important predictor of metastasis identified by Ms. Danial and her coinvestigators was having a primary tumor of the basosquamous histologic subtype. This was associated with a 6.5-fold increased risk of metastasis.
Eleven patients experienced metastasis to the lung. The second most common site was bone, in eight patients. All metastases were pathologically confirmed by tissue diagnosis.
The explanation for the markedly better overall survival in the Stanford series than in earlier reports is unclear. Improvements in treatment are one possibility. Another is that reporting bias may have been a factor in previous reports, with more aggressive cases of metastatic BCC having a greater likelihood of being published. Yet another possibility is that patients who are referred to Stanford for treatment are in better overall health than those featured in prior case reports, since they are able to travel to the academic medical center, Ms. Danial noted.
None of the various forms of chemotherapy, surgery, and radiation treatment utilized in Stanford patients with metastatic BCC was associated with a significant increase in overall survival. That being said, it’s too soon to know whether the Stanford patients involved in a clinical trial of vismodegib (Erivedge), the novel Hedgehog signaling pathway inhibitor, will experience a significant survival advantage over those who didn’t receive the drug.
The Stanford series presented by Ms. Danial also included 32 patients with locally advanced BCC. Their mean overall survival from the time of diagnosis of the primary tumor was 10.1 years. The primary tumor was located on the head or neck in 22 of the 32 patients, as was the case in 8 of 17 patients with metastatic BCC.
Ms. Danial reported having no relevant financial conflicts.