Evaluation of Sonidegib Cytoreductive Activity in Locally Advanced Basal Cell Carcinoma Treatment: A Delphi Consensus

Background: Basal cell carcinoma (BCC) is the most common cancer worldwide. If lesions are not treated for years or relapse after surgery and/or radiotherapy, they can become ‘locally advanced’ (laBCC). In some challenging BCC patients, the risk of a significant functional/aesthetic deficit advises against both complete surgical resection and radiotherapy. Medical therapies, such as the hedgehog pathway inhibitor (HHI) sonidegib, may be helpful to make patients eligible for other potentially curative techniques or for the long-term management of refractory cases or cases that are unsuitable for surgery and radiotherapy. A multidisciplinary board organized a Delphi consensus to understand the agreement around the cytoreductive HHI approach. Methods: A Delphi questionnaire with 17 statements (with a 7-point Likert scale) was administered via a customized web-based platform to Italian specialists with clinical activity/expertise in laBCC. In the second-round physicians were asked to answer the same statements considering the interquartile range of each question as an index of their colleagues' responses. Results: Forty-seven panelists, representative of the Italian territory, answered the questionnaire at the first round. For 16/17 statements of the Delphi, at the second round, more than 75% of panelists assigned a score of 4 or more reaching agreement; these statements also reached a high consensus, as the panelists assigned similar scores, with a low interquartile range. Conclusions: In the absence of solid scientific evidence, this article offers consensus-based recommendations on which patients may benefit from cytoreductive HHI, how to conduct the cytoreductive therapy, how to assess response to it and how to perform the surgery.