1. Patidegib gel 2% — topical
A Hedgehog inhibitor in an ointment — minimizing systemic absorption, and therefore fewer side effects like dysgeusia and alopecia. Phase 2 results were published in the British Journal of Dermatology in April 2025 (63% complete response in treated lesions). Phase 3 (Sol-Gel/SGT-610) completed enrollment in August 2025 — ~140 patients at 43 sites in the US, Canada and Europe. Top-line results expected Q4 2026.
Sources: BJD Phase 2 paper · Sol-Gel Q2 2025 update · Gorlin Syndrome Alliance (clinicaltrials@gorlinsyndrome.org)
2. Itraconazole — an old drug, a new use
A long-established, inexpensive antifungal drug found to be an indirect Hedgehog inhibitor. Phase IIb data (HP2001): 38 patients, 477 lesions, 57.7% response with ≥30% reduction. SUBA-Itraconazole (a proprietary amorphous formulation with improved absorption) is in development. In 2024 a PIND was filed with the FDA; in 2026 a Type C meeting was granted. The company (Inhibitor Therapeutics) is choosing a 505(b)(2) pathway — a PK study is underway in Malaysia, final sampling May 2026, followed by an NDA.
Source: INTI press release, March 2026
3. Sonidegib + PDT — combination
NCT06623201 — a trial combining a Hedgehog inhibitor (Sonidegib) with photodynamic therapy. Active, recruiting. The idea: synergy — less systemic drug, fewer side effects, increased efficacy. ClinicalTrials.gov NCT06623201
4. Itraconazole + Arsenic Trioxide (historical)
A 2016 Stanford study (Ally et al., JAMA Dermatology): a sequential combination reduced GLI1 mRNA by 75% from baseline in mBCC patients resistant to SMO inhibitors. No patient showed tumor shrinkage — possibly due to transient GLI1 suppression with sequential dosing. Research value as a proof-of-concept; not clinical practice. PMID 26765315
5. Drug Holiday Protocols
The MIKIE study (Lancet Oncology 2017) established two intermittent Vismodegib regimens (12 weeks on / 8 weeks off, and 24/8). Later studies (2023–2025) added quicker regimens (week-on/off, month-on/off). Maintaining efficacy with a significant reduction in side effects. Especially recommended in BCNS given the long-term treatment. Lancet Oncology MIKIE · Curr Treat Options Oncol 2025 review
6. SkinJect (D-MNA) — a microneedle patch with Doxorubicin New (July '26)
A new, non-surgical approach: a patch with dissolving microneedles that release Doxorubicin directly into the BCC lesion (intradermal), with a high local concentration and minimal systemic exposure. The advantage for a Gorlin patient — a treatment that can be repeated across multiple lesions, as an alternative to repeated surgeries. Medicus Pharma filed Orphan Drug Designation (April 2026) and Rare Pediatric Disease Designation (June 2026) requests with the FDA, and is planning a registrational Phase 2b trial in Gorlin patients (SKNJCT-004, up to 50 patients, 200µg dose, endpoint — complete clearance in ≥50% of lesions at week 10). In collaboration with the Gorlin Syndrome Alliance (GSA), an Expanded Access IND pathway is being advanced for compassionate access. Still investigational, not yet approved.
Sources: Medicus Pharma RPDD, June 2026 · ODD, April 2026