For basal cell carcinoma, an initial treatment success has been realized with imiquimod, which appears to be sustained over a five-year period, report researchers.
Basal cell carcinoma, a type of skin cancer the most common form of human cancer. With a growing aging population, BCC are rates are increasing at an alarming rate of around 10% per year. A new study published in the Journal of Investigative Dermatology examines the effectiveness of Imiquimod, A topical cream that could treat low-risk BCC lesions, over a 5year period. Investigators found that this topical cream has success rates sustained for the extended study period and did not promote recurrence.
Currently, the gold standard treatment for BCC is excision or Mohs surgery. However alternative treatments for BCC are emerging, many of which can be administered by general practitioners. One of the treatments is imiquimod, a topical treatment cream that boosts the body’s immune response. This extension of a prior study, which evaluates the effectiveness of imiquimod treatment, is based on a previously conducted RCT (Randomized control trial) that followed BCC patients for 3years post-treatment. The 1st study had an 83.6% success rate for patients treated with imiquimod, versus 98.4% for traditional surgery. In the additional 2 years of follow up time tracked study, researchers found that 82.5% imiquimod patients had successful outcomes at the 5-year mark compared to 97.7% surgery.
“The absolute response rate for topical imiquimod of 83% at five years, although clearly inferior to the 98% for excisional surgery for low-risk BCC, might still represent a clinically useful treatment modality, because a cream treatment can be carried out in a primary care setting, and some patients may also prefer the option of a cream rather than surgery,” remarked lead investigator Hywel C. Williams, DSc, FMedSci, NIHR Senior Investigator, Professor of Dermato-Epidemiology and Co-Director of the Centre of Evidence-Based Dermatology at the University of Nottingham, Nottingham, UK. “If you had told me 15 years ago that one day we would be treating low risk nodular and superficial BCC with a cream that enhanced the body’s local immune response, I would have walked away. But it is a reality nowadays.”
Doctors have expressed concerns that the use of topical treatments instead of surgery may leave patients vulnerable to so-called “submarine lesions”. Which can emerge after the superficial cancer appears to have been treated. However, with the 3-year follow up study and extended 5-year study, BCC recurrence is unlikely. Unsuccessful treatment recurs in the first year of treatment, a finding that throws light on the possible mechanisms of topical immunotherapy of skin cancer, suggesting that once an immunological response has occurred, such a response is sustained,” said Professor Williams.
These new data are important information for practitioners and their patients to consider with treatment options for low-risk BCC. The results are likely to hold for over a 5-year period. “Very few RCTs have been conducted for BCC, which is odd considering that it is the most common form of human cancer. Only a handful of such RCTs have been followed for 5 years, which is important as some treatments such as photodynamic therapy, produce reasonable results in the short term, but seem to result in more and more recurrences the longer patients are tracked.”
“The most important results are the precise estimates of three- and five-year tumor clearance for imiquimod cream versus surgery,” concluded Professor Williams. “This will allow patients and their doctors to engage in a shared decision-making conversation on a range of possible treatment options. Because BCC is reaching epidemic proportions, some countries like the UK are struggling to keep up. One possible strategy for the future is to treat more low-risk (biopsy proven) BCCs with imiquimod cream and only refer patients who don’t respond to secondary care services.”