title: Vismodegib for locally advanced basal cell carcinoma in a heart transplant patient.
abstract: OBJECTIVE
  Immunosuppressed patients with solid organ transplants have an increased risk for nonmelanoma skin cancer. Vismodegib has been reported to be effective for select locally advanced or metastatic basal cell carcinomas. However, there is no data documenting the use and safety of vismodegib in immunosuppressed organ transplant patients.
  
  
  METHODS
  We describe a 78-year-old white man with a history of orthotopic heart transplant, immunosuppressed with low-dose cyclosporine, who presented to a specialty dermatology transplant clinic with multiple, recurrent, locally aggressive facial basal cell carcinomas. Through a multidisciplinary approach, the patient was started on vismodegib therapy. The pharmacokinetics of cyclosporine in the setting of vismodegib administration and weekly monitoring of cyclosporine levels ensured that therapeutic immunosuppression levels were achieved without toxic effects.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report that details vismodegib use in an immunosuppressed heart transplant patient receiving cyclosporine therapy. With a growing immunosuppressed organ transplant population at high risk for basal cell carcinoma, therapeutic options for locally advanced or metastatic disease are limited. Vismodegib appears to be a safe option for patients receiving cyclosporine therapy with routine monitoring. Future research is needed to evaluate the safety profile of vismodegib with other immunosuppressive agents.
authors.affiliation: Department of Dermatology, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Carrie Ann
authors.initials: CA
authors.lastname: Cusack
authors.affiliation: Department of Dermatology, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Rohit
authors.initials: R
authors.lastname: Nijhawan
authors.affiliation: Department of Dermatology, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Brett
authors.initials: B
authors.lastname: Miller
authors.affiliation: Department of Dermatology, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Mira
authors.initials: M
authors.lastname: Henien
authors.affiliation: Division of Solid Organ Transplantation, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Gregory
authors.initials: G
authors.lastname: Malat
authors.affiliation: Division of Nephrology, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Alden
authors.initials: A
authors.lastname: Doyle
authors.affiliation: Department of Dermatology, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Mark
authors.initials: M
authors.lastname: Abdelmalek
mesh_terms: D000368:Aged; D000813:Anilides / Q000009:adverse effects / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002280:Basal Cell Carcinoma / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D016572:Cyclosporine / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D016903:Drug Monitoring / Q000379:methods; D005153:Facial Neoplasms / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D016027:Heart Transplantation / Q000379:methods; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D008297:Male; D011725:Pyridines / Q000009:adverse effects / Q000627:therapeutic use*; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology
chemical_list: D000813:Anilides; D000970:Antineoplastic Agents; C538724:HhAntag691; D007166:Immunosuppressive Agents; D011725:Pyridines; D016572:Cyclosporine