Maastricht University Medical Centre, Netherlands
Klara Mosterd has completed her Ph.D at the Maastricht University Medical Centre at the age of 30, one year after becoming a dermatologist. She is part of the Head and Neck team and next to her clinical work as a dermatologist specialized in oncology has conducted large phase 3 trials that have been published in reputed journals such as the Lancet Oncology. She is now focusing on translational research for BCC treatments.
Although surgical excision is still the gold standard treatment for BCC, the high incidence of BCC necessitates the use and further development of non-invasive therapies. Individual treatment may be offered based on guidelines and randomized trials, such as the trial we recently published in the Lancet Oncology comparing 3 topical treatments for superficial BCC. The choice for a treatment is not only based on response rates, but also involves practical aspects, cosmetic result and costs. Development of topical and systemic targeted therapy, such as SMO inhibition has opened new perspectives. However the cure rate of none of those treatments equals that of surgical excision. Probably, because more pathways are involved in the development of BCC. We performed mutation analysis in tissue secondary resistant to systemic SMO inhibition. The found information may offer insight in how we can improve targeted treatments. Although second-generation SMO-antagonists have already been developed, a different option is to combine different treatments, which is common in other oncological treatments. Targeting GLI may be an option and also Itraconazole has been found to inhibit the Hh pathway. We recently performed a phase 3 trial to investigate the effects of topical application of diclofenac 3% and/or calcitriol 3 ug/g on BCC. We found a good clinical response of the diclofenac cream to superficial BCC's. Results of this trial will be presented. The future of BCC treatment is non-invasive treatment. Combination of different agents may have the advantage of additive inhibitory effects and possibly minimizing the development of tumor resistance to a drug.