title: Patient with Gorlin syndrome and metastatic basal cell carcinoma refractory to smoothened inhibitors.
abstract: OBJECTIVE
  Basal cell carcinomas (BCCs) in patients with Gorlin syndrome have been reported to be extremely sensitive to Smoothened (SMO) inhibitors, a novel targeted therapy against the Hedgehog pathway, because of characteristic mutations in these patients. A few cases of disease refractory to oral therapy with SMO inhibitors have been reported in patients with Gorlin syndrome and nonmetastatic BCCs, but refractory disease in distantly metastatic tumors has not been documented in this high-risk group.
  
  
  METHODS
  A man with Gorlin syndrome and innumerable cutaneous BCCs presented with biopsy-proven BCC in his lungs. After SMO inhibitor therapy, almost all of his cutaneous tumors shrank, but his lung metastases did not. These lung metastases remained refractory to treatment despite institution of a second SMO inhibitor.
  
  
  CONCLUSIONS
  We report a case of Gorlin syndrome in a patient with metastatic BCC refractory to SMO inhibitors. Furthermore, clinical responses in this patient's cutaneous tumors did not parallel the responses in the distant site. However, serial imaging after diagnosis of metastatic disease can be critical to monitor for response to therapy.
authors.affiliation: Department of Dermatology, Stanford University School of Medicine, Redwood City, California.
authors.forename: Gefei A
authors.initials: GA
authors.lastname: Zhu
authors.affiliation: Department of Dermatology, Stanford University School of Medicine, Redwood City, California.
authors.forename: Angela S
authors.initials: AS
authors.lastname: Li
authors.affiliation: Department of Dermatology, Stanford University School of Medicine, Redwood City, California.
authors.forename: Anne Lynn S
authors.initials: AL
authors.lastname: Chang
mesh_terms: D000813:Anilides / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001478:Basal Cell Nevus Syndrome / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D002280:Basal Cell Carcinoma / Q000150:complications / Q000188:drug therapy* / Q000556:secondary; D019008:Drug Resistance, Neoplasm; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D011725:Pyridines / Q000627:therapeutic use*; D043562:Receptors, G-Protein-Coupled / Q000037:antagonists & inhibitors; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology; D000072086:Smoothened Receptor; D017211:Treatment Failure; D014704:Veratrum Alkaloids / Q000627:therapeutic use*
chemical_list: D000813:Anilides; D000970:Antineoplastic Agents; C538724:HhAntag691; C541444:IPI-926; D011725:Pyridines; D043562:Receptors, G-Protein-Coupled; C491023:SMO protein, human; D000072086:Smoothened Receptor; D014704:Veratrum Alkaloids