Hospital Real de Granada

Background and ImportanceBasal cell carcinoma (BCC) is the most common skin cancer, with advanced cases often difficult to treat using traditional methods like surgery and radiotherapy. The Hedgehog signalling pathway plays a key role in BCC, leading to treatments like vismodegib and sonidegib. This study evaluates their effectiveness and safety in real clinical settings.Aim and ObjectivesThe study aims to evaluate the effectiveness and safety of Hedgehog pathway inhibitors in patients with locally advanced or metastatic basal cell carcinoma. It focuses on treatment response, tumour recurrence, and adverse events, while comparing outcomes between vismodegib and sonidegib, two commonly used inhibitors in clinical practice.Material and MethodsA retrospective observational study was conducted on patients with locally advanced or metastatic basal cell carcinoma between December 2020 and March 2024. Data on demographics, tumour location, treatment details, and adverse events were collected. Patients received vismodegib or sonidegib, with treatment effectiveness assessed by disease recurrence. Quality of life was measured using the ECOG scale. Adverse events, dose modifications, and reasons for treatment discontinuation were also recorded. In some cases, neoadjuvant treatments were used to facilitate subsequent surgeries.ResultsThe study included 14 patients, of whom 64.29% were male and the mean age was 76.21 years. Most of the patients (57.14%) received off-label neoadjuvant treatment, and the rest were cases of inoperable locally advanced BCC. The tumours were predominantly located on the face (64.29% of cases). All patients treated with sonidegib had adverse events (ADRs), including haematologic toxicity and muscle damage, leading to discontinuation or dose adjustment in some cases. Adverse events were also experienced by 77.78% of vismodegib-treated patients. There was tumour recurrence in 25% of neoadjuvant-treated patients. Three patients treated with vismodegib were able to maintain response after more than 12 months, and four other patients with inoperable BCCla remain on treatment with significant tumour regression.Conclusion and RelevanceHedgehog pathway inhibitors, vismodegib and sonidegib, effectively treat locally advanced and metastatic BCC, offering an alternative to surgery or radiotherapy. Despite frequent adverse effects, they control disease and enable salvage surgeries. Further research is needed to compare effectiveness, manage side effects, and improve treatment adherence.References and/or AcknowledgementsConflict of InterestNo conflict of interest

The United Nations’ increasing involvement in global sustainability culminated in 2015 with the release of the 2030 Agenda. This agenda puts businesses in the spotlight, and their innovation and stakeholder partnering activities are portrayed as essential strategies for achieving an ambitious set of 17 Sustainable Development Goals (SDGs). In this study, we identify six distinct dynamic stakeholder engagement strategies—resilient specialists, opportunity explorers, uncommitted diversifiers, rainbow warriors, rainbow washers, and progressive learners—and distinguish two approaches to innovate, depending on the range of SDG targets aimed to achieve simultaneously. On the one hand, for firms that take a narrow approach intended to achieve a reduced set of SDG targets, we predict that successful dynamic stakeholder engagement strategies are those that end up with an intensive collaboration with a reduced number of stakeholder groups. On the other hand, for firms adopting a broad innovation approach to satisfy a wide set of SDG targets, we predict that successful dynamic stakeholder engagement strategies are those that end up interacting with a wide number of stakeholder groups. Longitudinal analysis of more than 3900 Spanish firms supports our predictions and suggests clear implications for responsible innovation research and the advancement of sustainable development through collaboration.