title: Pharmacologic treatment options for advanced epithelial skin cancer.
abstract: BACKGROUND
  Epithelial skin cancers (ESCs), namely basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), are considered common skin malignancies, with rising incidence rates over the past few decades. A subgroup of patients with ESC present with advanced and 'difficult'-to-treat tumours, including locally advanced and metastatic tumours. Currently, there is no widely accepted staging system for locally advanced ESCs, while metastatic BCCs and SCCs share a staging system. Therefore, selecting an appropriate therapeutic regimen for these patients may be difficult.
  
  
  METHODS
  The purpose of this review is to highlight the pharmacologic treatment options for advanced ESCs. These include 'conventional' chemotherapeutic regimens such as 5-fluorouracil, cisplatin, vincristine, bleomycin and doxorubicin and newer, more 'targeted' therapies.
  
  
  CONCLUSIONS
  Vismodegib, a Hedgehog (Hh) inhibitor, was recently approved for the treatment of advanced BCC showing a good efficacy rate and a relatively well-tolerated safety profile in clinical studies. In addition, a number of hedgehog inhibitors are now in Phase I and II trials of advanced BCC demonstrating encouraging results. Phase II studies with epithelial growth factor receptor inhibitors, such as cetuximab, gefitinib, panitimumab and erlotinib have been conducted in patients with advanced SCCs, used either as monotherapy or in combination with chemotherapy. However, there is still much knowledge to be gained about the treatment efficacies, optimal treatment durations, mechanisms of drug tolerance, adverse events and the ways in which these therapies influence patient outcomes and quality of life.
authors.affiliation: University of Athens School of Medicine, Andreas Sygros Hospital, Department of Dermatology-Venereology , 5 Dragoumi str, 16121, Athens , Greece +30 6977459330 ; +30 2107258476 ; anonaki@hotmail.com.
authors.forename: Efthymia
authors.initials: E
authors.lastname: Soura
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Chasapi
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Stratigos
mesh_terms: D000813:Anilides / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002280:Basal Cell Carcinoma / Q000188:drug therapy* / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000473:pathology; D002986:Clinical Trials as Topic; D019008:Drug Resistance, Neoplasm; D066246:ErbB Receptors / Q000037:antagonists & inhibitors; D000069347:Erlotinib Hydrochloride / Q000627:therapeutic use; D000077156:Gefitinib; D006801:Humans; D058990:Molecular Targeted Therapy; D011725:Pyridines / Q000627:therapeutic use; D011788:Quality of Life; D011799:Quinazolines / Q000627:therapeutic use; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000813:Anilides; D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; C538724:HhAntag691; D011725:Pyridines; D011799:Quinazolines; D000069347:Erlotinib Hydrochloride; C512478:EGFR protein, human; D066246:ErbB Receptors; D000077156:Gefitinib
keywords: EGFR inhibitors; Hedgehog pathway inhibitors; advanced BCC; advanced SCC