What are the Side Effects of Basal Cell Carcinoma Treatment Therapies?

All treatments can have side effects, and it’s important to know what to expect when you move forward with a treatment. Below are descriptions of common side effects from basal cell carcinoma (BCC) therapies and information on how to work with your healthcare team to manage these side effects.

Nomenclature: Side Effect

The term side effect refers to a consequence resulting from a therapy. Though most people think of a side effect as something negative, it can mean something positive or negative. Because side effect has dual meanings, medical texts and personnel more often use terms such as adverse drug effect, adverse event, or adverse reaction to describe negative treatment consequences. Here, we will simply use the term side effects to describe the burdensome issues you may face throughout your treatment. However, if you see the terms adverse reaction or adverse drug effect on your prescribing information packets, know that it means the same as side effect.

Side Effects of Surgery

Surgery carries both short- and long-term risks for side effects. Short-term effects of surgery such as bleeding, adverse reactions to medications, or difficulty closing the wound, will likely be addressed by your doctor in take-home information that you receive post-surgery. Another short- to longer-term complication that can occur after surgery is wound infection.

Other potential side effects from surgery include sensory nerve damage, lymphedema, and disfigurement. Sensory nerve damage can lead to localized numbness, a sensation of pins and needles, or burning or severe pain. Motor nerve damage can also occur, resulting in weakness or paralysis. In general, if the involved area is small, nerve damage may improve or resolve in approximately 12 months. However, sometimes the neurologic symptoms remain.

Lymphedema (lim·fuh·dee·muh) is an accumulation of fluid in the soft tissue from blockage and appears as swelling. It is caused by either damage to or the absence of your lymph nodes after surgically removing those channels which drain excessive fluid from our system. It can occur in the short-term or long-term for patients who had extensive surgery. A lymphedema therapist can help with skin care, massage, bandaging, exercises, or a compression garment. This treatment is called lymphedema therapy.

A major challenge that goes along with surgery for advanced BCC is the potential for unsightly cosmetic results. This can include loss or darkening of skin color, suture marks, or excessive scarring. When BCC is highly invasive, the degree of disfigurement can be substantial. Having a good reconstruction plan and follow-up with your surgeon is important.

Side Effects of Radiation Therapy

Side effects of radiation are usually restricted to the area that has been radiated and can include irritation of the skin, changes in skin color, and loss of hair in the area being treated. If treatment occurs in the head or neck area, side effects can include damage to salivary glands and teeth, taste changes, and swallowing difficulties. Fatigue is a common side effect of radiation that usually resolves.

Also worth noting is the long-term increase in new skin cancers in the area treated with radiation as a common side effect.

Side Effects of Immunotherapy—Cemiplimab (Libtayo)

The immunotherapy drug cemiplimab (Libtayo) is approved by FDA for treatment of BCC. This drug, also called an immune checkpoint inhibitor, increases the immune system’s fighting power, and that can cause considerable negative autoimmune-like responses.

Concerning side effects associated with immunotherapy can occur in the lungs, liver, skin, neurological system, cardiac system, and eyes. In addition, gastrointestinal inflammation may occur and hormonal problems affecting glands like the adrenal, pituitary, thyroid glands, and the pancreas are risks. Serious negative reactions occurred in a small portion of patients in clinical trials.

The management of immunotherapy’s side effects typically involves stopping treatment to address the problem. In moderate cases, corticosteroids are used to quiet the immune system, after which immunotherapy can be restarted. In severe cases, the immunotherapy drug may need to be discontinued. Reducing the immunotherapy dosage is not generally recommended.

This downloadable side effect management guide, LIBTAYO® (cemiplimab) can help you to recognize symptoms and work with your provider to manage your side effects. Please consider bringing these pages to your next appointment.

Side Effects of Hedgehog Inhibitors—Sonidegib (Odomzo) and Vismodegib (Erivedge)

There are a range of side effects associated with these two drugs, which are often referred to as hedgehog inhibitors.

The most important side effect to be considered is embryo-fetal toxicity, which means that these drugs can cause severe birth defects or fetal death. Importantly, women with reproductive potential should use effective contraception during treatment with either sonidegib or vismodegib during therapy and for 20 months after the last dose of sonidegib and 24 months after the last dose of vismodegib. Since these drugs can also be found in semen, men should use condoms to avoid potential drug exposure to pregnant partners or female partners with reproductive potential during therapy and for eight months after the last dose of sonidegib and three months after the final dose of vismodegib.