An example of a small, superficial BCC lesion that might be treated with imiquimod. Credit: Journal of Investigative Dermatology
Basal cell carcinoma (BCC) is the most common form of human cancer. With a growing aging population, BCC rates are climbing at an alarming rate, with reported cases rising by as much as 10% per year. A new study examines the effectiveness of imiquimod, a topical skin cream used to treat low-risk BCC lesions, over a five-year period. Imiquimod success rates were sustained for the extended study period and did not promote lesion reoccurrence.
Currently, the gold standard of treatment for BCC is excisional or Mohs surgery, both of which require a dermatologist or plastic surgeon. Requiring specialized care for such a ubiquitous and mostly low-risk cancer can tie up resources that are needed for more serious and difficult cases. In order to help alleviate some of the burden, alternative treatments for BCC are emerging, many of which can be administered by general practitioners. One of these treatments is imiquimod, a topical treatment cream that boosts the body’s immune response.
This extension of a prior study, which looks at the effectiveness of imiquimod treatment, is based on a previously conducted randomized control trial (RCT) that followed BCC patients for 3 years post-treatment. The first 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 in this new study, researchers found that 82.5% of imiquimod patients had successful outcomes at the 5-year mark compared to 97.7% for 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 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.
Doctors have expressed concerns that the use of topical treatments instead of surgery may leave patients vulnerable to “submarine lesions,” which can emerge after the superficial cancer appears to have been treated. However, mirroring the results of the 3-year follow-up, the extended 5-year study illustrates that if imiquimod treatment is successful in the first year, BCC reoccurrence is unlikely. “Most treatment failures with topical imiquimod occurred 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.
Investigators hope that these findings will encourage further research to develop creams that work in a similar way, yet produce better results. “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.” http://www.alphagalileo.org/ViewItem.aspx?ItemId=170942&CultureCode=en
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