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Muscle spasm and lack of efficacy: case report A 67-year old woman developed muscle spasm during treatment with sonidegib and vismodegib [routes not stated; not all dosages stated] for basal-cell carcinoma. Additionally, she exhibited lack of efficacy during treatment with magnesium for the muscle spasm. The woman, with multiple surgeries for basal-cell carcinomas (BCCs) in the past, first presented in 2010 with a large ulcerated BCC in the right frontal and parietal area. A tumor relapse was suspected. After full-body examinations, CT scans and blood workup, she showed multiple difficult to treat BCCs of the scalp. She was scheduled to undergo excisions, but she did not keep her appointments. She returned to the clinic 9 years later, in May 2019. Over the course of time, her pre-existing tumors and new lesions had grown dramatically; she had recurrent bleeding and was ashamed to leave the house. She refused to undergo excision or further human genetic diagnostic evaluation for possible abnormalities. She was then treated with standard vismodegib 150mg daily. However, she developed severe muscle spasms. The woman was tried on off-label vismodegib dose reduction to every other day, along with magnesium treatment. However, her cramps did not improve. Hence, her vismodegib was changed to sonidegib 200mg daily after one month. She initially tolerated the switch well. After two months of sonidegib treatment, she decided to discontinue it, as she still reported feeling impaired by intermittent muscle spasms. A partial remission was acheived following 3 months of treatment. After discontinuation of drug treatment, she did not report to center again. Niebel D, et al. Clinical Management of Locally Advanced Basal-Cell Carcinomas and Future Therapeutic Directions. Dermatology and Therapy 10: 835-846, No. 4, Aug 2020. Available from: URL: http://doi.org/10.1007/s13555-020-00382-y 803496944

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Reactions 22 Aug 2020 No. 1818