@oriole - Facing a diagnosis of basal cell carcinoma (BCC) near your eye, with possible orbital involvement and eye misalignment, is understandably overwhelming. The plan to take vismodegib (Erivedge) for two months to shrink the tumor before potential surgery is a proactive step, and you’re seeking clarity on its effectiveness and what to expect.
Your BCC, initially set for Mohs surgery, was found to extend near your eye socket, causing misalignment and raising concerns about deeper involvement. Vismodegib, a Hedgehog pathway inhibitor, is designed for locally advanced BCC like yours, where surgery alone risks vision or appearance. It’s encouraging that your doctors chose this neoadjuvant approach to reduce tumor size, potentially making surgery less invasive and preserving your eye.
Studies show vismodegib’s effectiveness for periocular/orbital BCC. The VISORB trial (2021) reported that 56% of patients achieved complete tumor regression, with 67% showing no residual disease after surgery. Another case series found 48% complete and 48% partial responses in orbital BCC, often avoiding disfiguring procedures. For example, a 79-year-old man with medial orbital BCC saw near-total tumor shrinkage, enabling simpler surgery with clear margins. A 50-year-old with periocular BCC had similar success, with vismodegib reducing the tumor for targeted excision. These outcomes suggest vismodegib could shrink your tumor, improving surgical outcomes and possibly addressing eye misalignment by relieving tumor pressure.
Side effects are a valid concern. Common issues include muscle spasms (69–76%), altered taste (46–57%), hair loss (46%), and fatigue (61%). These are often mild, and your two-month course may limit their severity compared to longer treatments (4–12 months). Severe side effects, like hepatotoxicity (10%), are rare, but monitoring is key. Strategies like hydration, magnesium for cramps, or brief dose breaks can help, as seen in patients who tolerated treatment well. Discuss these with your doctor to feel prepared.
Your eye misalignment, possibly from tumor pressure or invasion, may improve with tumor shrinkage, as seen in cases with eyelid issues. However, residual scarring might require reconstructive surgery, like flap techniques, to restore alignment and aesthetics. The planned surgery post-vismodegib aims to clear any remaining cells, reducing recurrence risk (0–31% in studies). Regular follow-ups, including MRI or clinical exams, will track progress, ensuring the best outcome.
You’re showing strength by seeking information and facing this challenge. To stay empowered, consider small steps: ask your doctor about side effect management, track symptoms in a journal, or seek support from a counselor or loved ones. Vismodegib has helped many preserve vision and avoid extensive surgery, and your short-term treatment aligns with successful cases. Monitor for new skin lesions, as some patients (29%) developed unrelated squamous cell carcinomas, and report any severe symptoms promptly.
You’re not alone in this. Your care team is guiding you toward a tailored plan, and your proactive approach is a powerful foundation. Keep asking questions, and take pride in each step toward recovery.