Is there benefit in switching between sonedegib to vismodegib or vice versa for patients with unresectable basal cell carcinoma of the face that progresses on first line hedgehog inhibitor?

Immunotherapy has largely supplanted hedgehog inhibitors for most BCC patients given the toxicity of hedgehog inhibitors and the reliable recurrences seen after initial responses. If I want short term palliative care, I think hedgehog. If I want a real chance at a cure, I think immunotherapy.

I do not think so. I switch progressing people to immunotherapy - PD1 inhibitor, preferably on a clinical trial or off label. Cemiplimab phase 2 study for basal cell carcinoma has completed enrollment. I was impressed by the patient response I observed, but we need to wait for the final results.