Basal cell carcinoma is the most common type of skin cancer. The drug vismodegib (Erivedge) has been approved to treat locally advanced basal cell carcinoma in patients who aren't surgery or radiation candidates; it has also been approved to treat metastatic basal cell carcinoma, the first drug to be approved for this indication. Vismodegib works by inhibiting a special pathway (known as the hedgehog pathway) that's active in most basal cell cancers, but not typically in normal cells. The drug is administered orally daily.

Vismodegib carries a boxed warning that it can cause severe birth defects, as well as death to an embryo or fetus. Men and women should both be advised of this warning. Women need to use a highly effective form of contraception (with a failure rate of less than 1%) while taking vismodegib and for at least seven months after their last dose. Men should use condoms and spermicide during intercourse, even if they've had a vasectomy, while using the medication and for at least two months after stopping treatment, because the drug may be expressed in semen. This advice is based on animal studies that found male and female reproductive function and fertility impairment. Vismodegib also carries a warning to patients not to donate blood or blood products during therapy or for at least seven months after stopping the drug.

The most common adverse reactions (occurring in 10% or more of patients) are muscle spasms, alopecia, altered or lost sense of taste, weight loss, fatigue, nausea, diarrhea, decreased appetite, constipation, arthralgias, and vomiting. Nurses should teach patients about the importance of contraception and the risks to a pregnancy. They should also inform patients that vismodegib capsules can be taken with or without food. The capsules should be swallowed whole and not crushed or broken. If a dose is missed, it should not be made up.

To read the Food and Drug Administration news release regarding vismodegib, go to http://1.usa.gov/z4uuiN.