PDT for Basal Cell Carcinoma: An Update

Basal cell carcinoma, or BCC, is by far the most common cancer in people with fair skin, accounting for eight out of every ten cases of non-melanoma skin cancer.  The cancer is often overlooked or misdiagnosed because of its pale color and general lack of symptoms, and because it develops slowly, sometimes over many years.  The standard treatment approach entails complete surgical removal, while radiation therapy is recommended for inoperable tumors or those where the post-operative defect would be cosmetically disfiguring or functionally disabling.  The incidence of BCC has been steadily increasing throughout Europe and North America.

In recent years, new therapeutic approaches have been developed for superficial BCC.  A recent clinical trial indicated that the immune-enhancing drug called imiquimod may be superior to methylaminolevulinate photodynamic therapy (MAL-PDT) for the treatment of this condition.  However, some medical scientists have suspected that the effectiveness of these modalities might depend on the specific subgroup of patients with superficial BCC.

Dermatology researchers at Maastricht University Medical Centre in Maastricht, the Netherlands, sought to determine whether the relative effectiveness of MAL-PDT and imiquimod is consistent across different subgroups of patients based mainly on their specific tumor characteristics. The Dutch research team analyzed data from 202 patients receiving MAL-PDT and 198 undergoing treatment with imiquimod.

In general, Imiquimod seemed to be a more effective treatment for superficial BCC; however, MAL-PDT seemed to be the better treatment choice for older patients with superficial BCC on the lower extremities.  In this group of patients, MAL-PDT was tolerated much better than Imiquimod and showed favorable efficacy. Because of the exploratory nature of this study, the authors encourage the conduct of more controlled studies in order to sort out the effects of patient subgroups  different treatment factors, as reported ahead-of-print in the 26 July 2014 British Journal of Dermatology.

Another promising research focus will be to consider the potential synergy between PDT and radiotherapy.  At this time, there are only a limited number of high-quality prospective studies of radiotherapy for BCC.  Based on the available evidence, radiotherapy appear to provide a high rate of local control with low rates of complications that are comparable to surgery.  It is conceivable that the combination of PDT with radiotherapy could enable less intensive treatment or lower doses of radiation to be used for superficial BCC.

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Sources

Roozeboom MH, Nelemans PJ, Mosterd K, Steijlen PM, Arits AH, Kelleners-Smeets NW. Photodynamic therapy versus topical imiquimod for treatment of superficial basal cell carcinoma: a subgroup analysis within a non-inferiority randomised controlled trial. Br J Dermatol. 2014 Jul 26. [Epub ahead of print]

Cho M, Gordon L, Rembielak A, Woo TC. Utility of Radiotherapy for Treatment of Basal Cell Carcinoma: Review. Br J Dermatol. 2014 Jul 12. [Epub ahead of print]

Berking C, Hauschild A, Kölbl O, Mast G, Gutzmer R.  Basal cell carcinoma-treatments for the commonest skin cancer. Dtsch Arztebl Int. 2014 May 30;111(22):389-95.

Peris K1, Tambone S, Kostaki D, Varrassi E, Fargnoli MC. Treatments of advanced basal cell carcinoma: a review of the literature. G Ital Dermatol Venereol. 2014 Jun 30. [Epub ahead of print]

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