How have you used Hedgehog pathway inhibitors as neoadjuvant/adjuvant therapies?   

I am presuming that the question is directed towards Basal cell cancer. We don't use Hedgehog pathway inhibitors (HHIs) in an adjuvant setting, but sometimes in the neoadjuvant setting, when the risk of getting a positive margin is high. I prefer alternate-day dosing of vismodegib (less muscle cram...

We use vismodegib or sonidegib for neoadjuvant treatment before surgery, sometimes in patients with extremely large BCCs or BCC nevus syndrome. We have also had rare cases of adjuvant treatment in patients requiring neurosurgery for extensive tumor invasion or metastatic disease.