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Meng L, Wei Y, Xiao Y. Chemo-immunoablation of solid tumors: A new concept in tumor ablation. Front Immunol 2023; 13:1057535. [PMID: 36713427 PMCID: PMC9878389 DOI: 10.3389/fimmu.2022.1057535] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/09/2022] [Indexed: 01/13/2023] Open
Abstract
Chemical ablation was designed to inject chemical agents directly into solid tumors to kill cells and is currently only used clinically for the palliative treatment of tumors. The application and combination of different drugs, from anhydrous ethanol, and glacial acetic acid to epi-amycin, have been clinically tested for a long time. The effectiveness is unsatisfactory due to chemical agents' poor diffusion and concentration. Immunotherapy is considered a prospective oncologic therapeutic. Still, the clinical applications were limited by the low response rate of patients to immune drugs and the immune-related adverse effects caused by high doses. The advent of intratumoral immunotherapy has well addressed these issues. However, the efficacy of intratumoral immunotherapy alone is uncertain, as suggested by the results of preclinical and clinical studies. In this study, we will focus on the research of immunosuppressive tumor microenvironment with chemoablation and intratumoral immunotherapy, the synergistic effect between chemotherapeutic drugs and immunotherapy. We propose a new concept of intratumoral chemo-immunoablation. The concept opens a new perspective for tumor treatment from direct killing of tumor cells while, enhancing systemic anti-tumor immune response, and significantly reducing adverse effects of drugs.
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Affiliation(s)
- Liangliang Meng
- Department of Radiology, the First Medical Center, Chinese PLA General Hospital, Beijing, China,Department of Radiology, Chinese PAP Hospital of Beijing, Beijing, China
| | - Yingtian Wei
- Department of Radiology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yueyong Xiao
- Department of Radiology, the First Medical Center, Chinese PLA General Hospital, Beijing, China,*Correspondence: Yueyong Xiao,
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Duvillard C, Romanet P, Cosmidis A, Beaudouin N, Chauffert B. Phase 2 Study of Intratumoral Cisplatin and Epinephrine Treatment for Locally Recurrent Head and Neck Tumors. Ann Otol Rhinol Laryngol 2016; 113:229-33. [PMID: 15053208 DOI: 10.1177/000348940411300312] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Local relapses of head and neck tumors are not often eligible for surgical and/or radiotherapy retreatment, and the efficacy of systemic chemotherapy is poor. A greater accumulation and efficacy of anticancer drugs with lower systemic toxicity is theoretically obtained with intratumoral chemotherapy. In experimental studies, epinephrine has been shown to increase the concentration and antitumor effect of intratumoral cisplatin. Fourteen patients with locally recurrent head and neck tumors (median age, 58.7 years) were included in this phase 2 trial. Recurrent tumors (squamous cell carcinomas) were located on the tongue, oral pharynx, or cervical nodes. Prior therapy was surgery and/or radiotherapy with or without intravenous chemotherapy. Inclusion criteria included an Eastern Cooperative Oncology Group/World Health Organization performance status of 0, 1, or 2, an anticipated survival of >3 months, adequate cardiac, kidney, liver, and bone marrow function, and no coagulopathy or carotid invasion. Fifty intratumoral injections of cisplatin-epinephrine (average, 3.6 injections per patient; range, 1 to 5 injections) were given to the 14 patients from November 1998 to July 2000. Patients were treated with cisplatin (1 mg/mL; maximum dose, 50 mg) at an injection volume corresponding to the tumor volume (1 mL/cm3 of tumor; maximum volume, 50 mL). Epinephrine was added at a concentration of 0.02 mg/mL. Intratumoral injections were repeated every 2 to 3 weeks at different locations in the tumors to obtain a homogeneous distribution. Tumor response was evaluated by clinical examination and computed tomography. Eight objective responses were registered among the 14 patients. Four were complete responses, and 4 were partial responses. The average time to disease progression was 11.5 ± 8.9 weeks. Local adverse effects were transient pain, swelling, and erythema at the site of the injection. No nephrotoxicity, neurotoxicity, or ototoxicity was observed. Intratumoral injection of cisplatin and epinephrine in an aqueous solution has a definite antitumor activity in recurrent head and neck cancer with acceptable local tolerance and no major systemic toxic effects except for transient tachycardia and high blood pressure at the time of injection.
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Affiliation(s)
- Christian Duvillard
- Department of Otolaryngology-Head and Neck Surgery, Hôpital Général, Dijon, France
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Metterle L, Nelson C, Patel N. Intralesional 5-fluorouracil (FU) as a treatment for nonmelanoma skin cancer (NMSC): A review. J Am Acad Dermatol 2015; 74:552-7. [PMID: 26577512 DOI: 10.1016/j.jaad.2015.09.040] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 09/16/2015] [Accepted: 09/17/2015] [Indexed: 01/30/2023]
Abstract
The treatment paradigm for nonmelanoma skin cancer remains surgical. This fact combined with its remarkably high incidence positions it as the fifth most costly cancer to treat in the Medicare population. To address this, consideration of alternative medical therapeutics is warranted. Intralesional 5-fluorouracil is a potentially affordable option that may demand further investigation. This literature review examines current data on its efficacy and adverse effects.
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Affiliation(s)
- Lauren Metterle
- University of South Florida College of Medicine, Tampa, Florida
| | | | - Nishit Patel
- University of South Florida College of Medicine, Tampa, Florida.
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Mooney R, Weng Y, Garcia E, Bhojane S, Smith-Powell L, Kim SU, Annala AJ, Aboody KS, Berlin JM. Conjugation of pH-responsive nanoparticles to neural stem cells improves intratumoral therapy. J Control Release 2014; 191:82-9. [PMID: 24952368 PMCID: PMC4156897 DOI: 10.1016/j.jconrel.2014.06.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 06/06/2014] [Accepted: 06/11/2014] [Indexed: 12/31/2022]
Abstract
Intratumoral drug delivery is an inherently appealing approach for concentrating toxic chemotherapies at the site of action. This mode of administration is currently used in a number of clinical treatments such as neoadjuvant, adjuvant, and even standalone therapies when radiation and surgery are not possible. However, even when injected locally, it is difficult to achieve efficient distribution of chemotherapeutics throughout the tumor. This is primarily attributed to the high interstitial pressure which results in gradients that drive fluid away from the tumor center. The stiff extracellular matrix also limits drug penetration throughout the tumor. We have previously shown that neural stem cells can penetrate tumor interstitium, actively migrating even to hypoxic tumor cores. When used to deliver therapeutics, these migratory neural stem cells result in dramatically enhanced tumor coverage relative to conventional delivery approaches. We recently showed that neural stem cells maintain their tumor tropic properties when surface-conjugated to nanoparticles. Here we demonstrate that this hybrid delivery system can be used to improve the efficacy of docetaxel-loaded nanoparticles when administered intratumorally. This was achieved by conjugating drug-loaded nanoparticles to the surface of neural stem cells using a bond that allows the stem cells to efficiently distribute nanoparticles throughout the tumor before releasing the drug for uptake by tumor cells. The modular nature of this system suggests that it could be used to improve the efficacy of many chemotherapy drugs after intratumoral administration.
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Affiliation(s)
- Rachael Mooney
- Department of Neurosciences, Beckman Research Institute at City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA.
| | - Yiming Weng
- Department of Molecular Medicine, Beckman Research Institute at City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Elizabeth Garcia
- Department of Neurosciences, Beckman Research Institute at City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Sukhada Bhojane
- Department of Molecular Medicine, Beckman Research Institute at City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Leslie Smith-Powell
- Department of Analytical Pharmacology, Beckman Research Institute at City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Seung U Kim
- Division of Neurology, Department of Medicine, UBC Hospital, University of British Columbia, Vancouver, British Columbia V6T2B5, Canada
| | - Alexander J Annala
- Department of Neurosciences, Beckman Research Institute at City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Karen S Aboody
- Department of Neurosciences, Beckman Research Institute at City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA; Division of Neurosurgery, Beckman Research Institute at City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Jacob M Berlin
- Department of Molecular Medicine, Beckman Research Institute at City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA.
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Clark CM, Furniss M, Mackay-Wiggan JM. Basal cell carcinoma: an evidence-based treatment update. Am J Clin Dermatol 2014; 15:197-216. [PMID: 24733429 DOI: 10.1007/s40257-014-0070-z] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most common skin cancer. Surgical excision remains the standard of treatment, but several alternative treatment modalities exist. OBJECTIVES This review aims to provide a current analysis of evidence for the treatment of BCC; specifically, which treatments have the lowest recurrence rates and the best cosmetic outcomes. METHODS We searched PubMed (January 1946 to August 2013), Ovid MEDLINE (2003-August 2013), the Cochrane Central Register of Controlled Trials (January 1993 to August 2013), and the Cochrane Database of Systematic Reviews (The Cochrane Library Issue 9, 2013) databases for randomized controlled trials, systematic reviews, or comparative studies for the treatment of BCC. RESULTS We found 615 potential articles. Two independent reviewers selected 40 studies: 29 randomized controlled trials (RCTs), seven systematic reviews, and four nonrandomized prospective trials. Treatment modalities reviewed include surgical therapy, radiotherapy and cryotherapy, photodynamic therapy (PDT), topical imiquimod, topical 5-fluorouracil (5-FU), topical solasodine glycoalkaloids, topical ingenol mebutate, intralesional 5-FU, intralesional interferon (IFN), and oral hedgehog pathway inhibitors. CONCLUSIONS The available data suggest that surgical methods remain the gold standard in BCC treatment, with Mohs micrographic surgery typically utilized for high-risk lesions. Suitable alternate treatment options for appropriately selected primary low-risk lesions may include PDT, cryotherapy, topical imiquimod, and 5-FU. Radiotherapy is a suitable alternate for surgical methods for treatment in older patient populations. Electrodesiccation and curettage (ED&C) is a commonly used primary treatment option for low-risk lesions; however, there were no RCTs examining ED&C that met our inclusion criteria. New hedgehog pathway inhibitors are promising for the management of advanced BCC; however, side effects are a concern for some patients, and much remains to be learned regarding optimal treatment length, risk of recurrence, and potential development of resistance. There is insufficient evidence at present to make recommendations on topical solasodine glycoalkaloids, topical ingenol mebutate, and intralesional 5-FU and IFN-α. Overall continued research on the efficacy of treatment modalities is needed. In particular, studies should include histologic ascertainment of clearance, long-term follow-up, stratification based on tumor subtype, and comparison with surgical outcomes.
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Affiliation(s)
- Charlotte M Clark
- Department of Dermatology, Columbia University Medical Center, New York, NY, 10032, USA
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Kim DD, Tang JY, Ioannidis JPA. Network geometry shows evidence sequestration for medical vs. surgical practices: treatments for basal cell carcinoma. J Clin Epidemiol 2014; 67:391-400. [PMID: 24491794 DOI: 10.1016/j.jclinepi.2013.10.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 09/29/2013] [Accepted: 10/07/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Basal cell carcinoma (BCC) is the most common cancer with 2 million treatments per year with little evidence-based guidelines for treatment. There are three classes of interventions (surgical, destructive, and topical) for BCC, and this study aimed to determine whether there are preferences or avoidances in comparisons of different types of treatments for BCC in randomized controlled trials (RCTs). STUDY DESIGN AND SETTING PubMed, Cochrane Central Registry of Clinical Trials, and ClinicalTrials.Gov were used to identify eligible published and registered ongoing RCTs. RESULTS Fifty-five trials (42 published and 13 registered trials) were identified. Only one unpublished registered trial compared a topical vs. a surgical intervention, and only one trial compared a topical vs. a destructive intervention. Conversely, 44 of the 55 trials compared interventions within the same treatment class and 9 of 55 trials compared surgical vs. destructive interventions. In most trials, selection of same-class comparators was not necessitated by the type of BCC lesions (nonaggressive superficial or nodular vs. aggressive, infiltrative, morpheic BCCs, P = 0.155) or their location (face vs. nonfacial, P = 0.137). CONCLUSION This is the first time that an evaluation of network geometry is applied to address issues of comparisons between different families of interventions that belong to different specialties and practices (medical vs. surgical). Previous evaluations of homophily have addressed different families of interventions, in which all interventions are medical (drugs) and performed in the same health-care settings. The noncommunicating bodies of evidence between medical and surgical interventions that we document highlight a problem of unnecessary sequestration of the evidence and the corresponding health-care practices.
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Affiliation(s)
- David D Kim
- Department of Dermatology, Stanford University School of Medicine, 450 Broadway St, Redwood City, CA 94063, USA
| | - Jean Y Tang
- Department of Dermatology, Stanford University School of Medicine, 450 Broadway St, Redwood City, CA 94063, USA
| | - John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine, Medical School Office Building, Room X306, 1265 Welch Rd, Stanford, CA 94305, USA; Department of Health Research and Policy, Stanford University School of Medicine, Redwood Building T152, 150 Governor's Lane, Stanford, CA 94305, USA.
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Murchison AP, Walrath JD, Washington CV. Non-surgical treatments of primary, non-melanoma eyelid malignancies: a review. Clin Exp Ophthalmol 2011; 39:65-83; quiz 92-3. [PMID: 21040309 DOI: 10.1111/j.1442-9071.2010.02422.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The diagnosis and management of periocular cutaneous malignancies are essential components of an ophthalmologist's practice. Skin cancers comprise nearly one-third of newly diagnosed malignancies. Furthermore, the incidence of skin cancer appears to be increasing. Multiple treatment modalities exist for periocular cutaneous malignancy. Surgical extirpation, often with the combined expertise of a Mohs micrographic surgeon, is typically the first line therapy and is often curative in the periocular region, depending on a variety of factors, including tumour histology, specific location, depth of invasion and surgical technique. However, there are instances where a less invasive, non-surgical treatment option is warranted, including patients who are poor surgical risks or those with diffuse disease. The purpose of this article is to review the literature and describe the non-surgical treatment options, indications and efficacies for non-melanoma primary eyelid malignancies.
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Affiliation(s)
- Ann P Murchison
- Oculoplastic and Orbital Surgery Service, Wills Eye Institute, Philadelphia, Pennsylvania 19107, USA.
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9
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Aguayo-Leiva I, Ríos-Buceta L, Jaén-Olasolo P. Surgical vs Nonsurgical Treatment of Basal Cell Carcinoma. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/s1578-2190(10)70698-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Guiu S, Guiu B, Feutray S, Chauffert B. Direct intratumoral chemotherapy with carboplatin and epinephrine in a recurrent cervical chordoma: case report. Neurosurgery 2009; 65:E629-30; discussion E630. [PMID: 19687674 DOI: 10.1227/01.neu.0000350864.78326.14] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Chordomas are rare primary bone tumors for which surgery is classically the first-line treatment. However, safe margins are often difficult to obtain, so that patients are at risk of local recurrence. Because radiation therapy and systemic chemotherapy show limited effectiveness, we report the use of direct intratumoral chemotherapy (IC) to treat recurrent chordoma. CLINICAL PRESENTATION A 46-year-old man presented with a recurrent cervical chordoma after surgery and radiation therapy. This recurrence manifested as C4-C5 spinal cord compression. TECHNIQUE Three 22-gauge needles were inserted at the upper, middle, and lower parts of the tumor and advanced under computed tomographic guidance while injecting local anesthetic. A 5-mg/mL carboplatin solution was combined with epinephrine (to increase the concentration and antitumor effect of carboplatin) at a final concentration of 0.01 mg/mL and an iodinated contrast agent. We injected 3 to 5 mL of this solution over 5 minutes through each needle under computed tomographic guidance. Eleven intratumoral treatments were performed during an 18-month period. CONCLUSION A marked clinical response with regression of the spinal cord compression was observed, without specific toxicity. A good partial response was obtained with a 42% decrease in tumor volume (from 69 to 40 cm3). Moreover, the central part of the tumor showed tumor necrosis, as confirmed by histological examination. Thus, in patients with this rare tumor, intratumoral chemotherapy may be a valid treatment option when surgery and radiation therapy fail. Furthermore, intratumoral chemotherapy in combination with surgical treatment should be considered to improve the local control rate.
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Affiliation(s)
- Séverine Guiu
- Department of Oncology, Georges-François Leclerc Anticancer Center, Dijon, France.
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Vena G, Coviello C, Mastrolonardo M, Foti C, Angelini G. Topical 5-fluorouracil in the treatment of discoid lupus erythematosus. Preliminary study over two years. J DERMATOL TREAT 2009. [DOI: 10.3109/09546639609086880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Duvillard C, Polycarpe E, Romanet P, Chauffert B. [Intratumoral chemotherapy: experimental data and applications to head and neck tumors]. ACTA ACUST UNITED AC 2007; 124:53-60. [PMID: 17434136 DOI: 10.1016/j.aorl.2006.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2006] [Accepted: 08/23/2006] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Intratumoral chemotherapy consists in the direct intratumoral injection of the anticancer drugs. Despite its simple and logical principle it remains relatively little used. MATERIAL AND METHODS This work reviews and analyses the national and international literature about experimental and clinical studies of intratumoral chemotherapy. RESULTS Numerous experimental studies validated its theoretical advantages compared with the intravenous one: drug intratumoral concentration increase, antitumoral activity improvement and systemic toxicity decrease. But they also underlined its limits: the high clearance and the non-homogeneous drug diffusion. Research works led to the improvement of the results and performed clinical trials with slow release devices (microspheres, collagen matrix with or without vasoconstrictive agent), anticancer drug in an aqueous solution with a vasoconstrictive agent, intratumoral injection in association with electrochemotherapy or radiotherapy. These trials showed the feasibility of this technique with, in recurrent tumors, response rate between 27 and 50% and an increase in quality of life. The more frequent adverse effects were pain in 24 to 80% of cases, ulceration, necrosis and oedema of the treated locations in 53 to 87,4% of cases and during the use of vasoconstrictive agents systemic effects like arterial hypertension and extrasystoles. CONCLUSIONS Intratumoral chemotherapy is an effective therapeutic even when used after the classical treatments. Improvements are necessary to define the best drugs, injection technique, treatment periodicity and indications. Intratumoral chemotherapy deserves better interest at the moment where drugs and antibodies limit their action to the cancer cells preserving the healthy ones.
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Affiliation(s)
- C Duvillard
- Service d'Otorhinolaryngologie et de Chirurgie Cervicofaciale, Hôpital Général, CHU de Dijon, 21033 Dijon cedex, France.
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Abstract
BACKGROUND Basal cell carcinoma (BCC) is the commonest skin cancer. BCCs are slow-growing, locally invasive, epidermal skin tumours which mainly affect white skinned people. The first line treatment is usually surgical excision, but numerous alternatives are available. OBJECTIVES To assess the effects of treatments for basal cell carcinoma. SEARCH STRATEGY We searched the Cochrane Skin Group Specialised Register (January 2006), the Cochrane Central Register of Controlled Trials (The Cochrane LIbrary Issue 1, 2006), the Cochrane Database of Systematic Reviews (The Cochrane Library Issue 1, 2006), MEDLINE (2004 to January 2006), EMBASE (2005 to January 2006), the metaRegister of Controlled Trials (February 2006). Cited references of all trials identified and key review articles were searched. Pharmaceutical companies were contacted where appropriate for reviews or unpublished trials. SELECTION CRITERIA Inclusion criteria were adults with one or more histologically proven, primary basal cell carcinoma. The primary outcome measure was recurrence at three to five years, measured clinically. The secondary outcome included early treatment failure within six months, measured histologically. Adverse treatment effects included aesthetic appearance and pain during and after treatment. DATA COLLECTION AND ANALYSIS Two authors independantly carried out study selection and assessment of methodological quality. MAIN RESULTS Twenty seven studies were identified. Only one RCT of surgery versus radiotherapy had primary outcome data at four years, showing significantly more persistent tumours and recurrences in the radiotherapy group as compared to the surgery group, (RR 0.09, 95%CI, 0.01 to 0.69). One study found no significant difference for recurrence at 30 months when Moh's micrographic surgery was compared to surgery for high risk facial BCCs, (RR 0.64, 95%CI 0.16,2.64). One study of methylaminolevulinate photodynamic therapy (MAL PDT) versus cryotherapy found no significant difference in recurrences in the MAL PDT group when compared to cryotherapy at one year (RR 0.50, 95% CI 0.22,1.12). Cryotherapy showed no significant difference in recurrences at one year when compared to surgery on one small study. When radiotherapy was compared to cryotherapy there were significantly fewer recurrences at one year in the radiotherapy group compared to the cryotherapy group.Short-term studies suggest a success rate of 87 to 88% for imiquimod in the treatment of superficial BCC using a once-daily regimen for 6 weeks and a 76% treatment response when treating nodular BCC for 12 weeks, when measured histologically. AUTHORS' CONCLUSIONS Overall there has been very little good quality research on treatments for BCC. Most trials have only evaluated BCCs in low risk locations. Surgery and radiotherapy appear to be the most effective treatments with surgery showing the lowest failure rates. Although cosmetic outcomes appear good with PDT, long term follow up data are needed. Other treatments might have some use but few have been compared to surgery. An ongoing study comparing imiquimod to surgery should clarify whether imiquimod is a useful option.
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Affiliation(s)
- F J Bath-Hextall
- School of Nursing, University of Nottingham, Faculty of Medicine and Health Science, Room D83, Medical School, Queens Medical Centre, Nottingham, UK, NG7 2UH.
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Gavini E, Manunta L, Giua S, Achenza G, Giunchedi P. Spray-dried poly(D,L-lactide) microspheres containing carboplatin for veterinary use: in vitro and in vivo studies. AAPS PharmSciTech 2005; 6:E108-14. [PMID: 16353954 PMCID: PMC2750418 DOI: 10.1208/pt060117] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was the development of a veterinary dosage form constituted by injectable biodegradable microspheres designed for the subcutaneous release of carboplatin, a chemotherapeutic drug. Poly(D,L-lactide) (PDLLA) microspheres were prepared by an emulsification/spray-drying method, using the drug-to-polymer weight ratios 1:9 and 1:5; blank microspheres (1% w/v) were prepared as a comparison. Microparticles were characterized in terms of morphology, encapsulation efficiency, and in vitro drug release behavior. In vivo tests were conducted on rats by subcutaneous injection of microsphere aqueous suspensions. Levels of carboplatin were evaluated both in the skin and in serum. The microparticles obtained had a spherical shape; particle size ranged from 5 to 7 microm, dependent on drug loading. Microspheres were able to control the in vitro release of the drug: approximately 90% to 100% of the carboplatin was released over 30 days. In vivo results showed that the microspheres were able to release high drug amounts locally, and sustained serum levels of drug were also achieved. Based on these results, carboplatin-loaded PDLLA microspheres may be useful for local delivery of the antineoplastic drug to the tumor, avoiding tumor recurrence in small animals, and may decrease the formation of distant metastases.
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Affiliation(s)
- Elisabetla Gavini
- Dipartimento di Scienze del Farmaco, University of Sassari, via Muroni 23/a, 07100 Sassari, Italy
| | - Lucia Manunta
- Istituto di Clinica Chirurgica Veterinaria, University of Sassari, 07100 Sassari, Italy
| | - Stefano Giua
- Istituto di Clinica Chirurgica Veterinaria, University of Sassari, 07100 Sassari, Italy
| | - Giannina Achenza
- Istituto Zooprofilattico Sperimentale della Sardegna, 07100 Sassari, Italy
| | - Paolo Giunchedi
- Dipartimento di Scienze del Farmaco, University of Sassari, via Muroni 23/a, 07100 Sassari, Italy
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Abstract
The majority of information on oncology therapies has been reported in humans, canine, and feline patients, and laboratory animals with experimentally induced tumors. A variety of treatments,including radiation therapy, chemotherapy, photodynamic therapy, and others have been used with exotic animals. There are many species of exotic pets, and anatomic differences, as well as husbandry and nutritional requirements, must be taken into account to provide optimal care. By providing a broad overview of therapies and considerations for treatment, this article is intended to provide the practitioner with an overview of approach and options when addressing oncology cases in exotic animals.
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Affiliation(s)
- Jennifer E Graham
- Department of Comparative Medicine, School of Medicine, University of Washington, Box 357190, Seattle, WA 98195-7190, USA.
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17
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Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most common skin malignancy in humans. BCCs are defined as slow-growing, locally invasive, malignant (but not life threatening), epidermal skin tumours which mainly affect white skinned people. The first line treatment is usually surgical excision, but numerous alternatives are available. OBJECTIVES To assess the effects of treatments for basal cell carcinoma. SEARCH STRATEGY We searched the Cochrane Database of Systematic Reviews (2002 issue 1) and Cochrane Controlled Trials Register (2002 issue 1), the Cochrane Skin Group Specialised Register (January 2002), MEDLINE (from 1966-2002), EMBASE (from 1980-2002), the Mega Register of Controlled trials and the National Research Register (2002 issue 1). In addition the cited references of all trials identified and key review articles were searched. Pharmaceutical companies were contacted where appropriate for reviews or unpublished trials. SELECTION CRITERIA Inclusion criteria were adults with one or more histologically proven, primary basal cell carcinoma. The primary outcome measure was recurrence at 3- 5 years, measured clinically. The secondary outcome included early treatment failure within 6 months, measured histologically. Adverse effect of treatment was evaluated by reviewing aesthetic appearance (to patient and blinded observer) and pain during and after treatment. DATA COLLECTION AND ANALYSIS Study selection and assessment of methodological quality were carried out by two independent reviewers. MAIN RESULTS 19 studies (13 published and 6 abstracts) were identified which include 7 broad therapeutic categories. Only one RCT of surgery versus radiotherapy had primary outcome data at four years, which showed that there were significantly more persistent tumours and recurrences, measured histologically, in the radiotherapy group as compared to the surgery group, which translates to an odds ratio of 0.09 (95%CI, 0.01 to 0.67) in favour of surgery. Cryotherapy, although convenient and less expensive than surgery, showed no significant difference in recurrences at one year, measured clinically, when compared to surgery, OR 0.23 (0.01 to 6.78). However when radiotherapy was compared to cryotherapy there were significantly more recurrences at one year, measured histologically, in the cryotherapy group, this translates to an odds ratio of 14.80 (95%CI, 3.17 to 69) in favour of radiotherapy. Preliminary studies suggest a high success rate (87-88%) for imiquimod in the treatment of superficial BCC using a once-daily regimen for 6 weeks and a useful (76%) treatment response when treating nodular BCC for 12 weeks, when measured histologically. However this cream has not been compared to surgery. REVIEWER'S CONCLUSIONS There has been very little good quality research on efficacy of the treatment modalities used. Most of the trials have looked only at BCCs in low risk areas. Surgery and radiotherapy appear to be the most effective treatments with surgery showing the lowest failure rates. Other treatments might have some use but few have been compared to surgery. Imiquimod emerged as a possible new treatment although it has not been compared to surgery or any other modality.
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Affiliation(s)
- F J Bath
- Faculty of Medicine and Health Science., School of Nursing, Mansfield Education Centre, Kings Mill Centre, Mansfield Road, Sutton-in -Ashfield, Nottingham, UK, NG17 4JL.
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Goldberg EP, Hadba AR, Almond BA, Marotta JS. Intratumoral cancer chemotherapy and immunotherapy: opportunities for nonsystemic preoperative drug delivery. J Pharm Pharmacol 2002; 54:159-80. [PMID: 11848280 DOI: 10.1211/0022357021778268] [Citation(s) in RCA: 148] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The recent literature documents the growing interest in local intratumoral chemotherapy as well as systemic preoperative chemotherapy with evidence for improved outcomes using these therapeutic modalities. Nevertheless, with few exceptions, the conventional wisdom and standard of care for clinical and surgical oncology remains surgery followed by radiation and/or systemic chemotherapy, as deemed appropriate based on clinical findings. This, in spite of the fact that the toxicity of conventional systemic chemotherapy and immunotherapy affords limited effectiveness and frequently compromises the quality of life for patients. Indeed, with systemic chemotherapy, the oncologist (and the patient) often walks a fine line between attempting tumour remission with prolonged survival and damaging the patient's vital functions to the point of death. In this context, it has probably been obvious for more than 100 years, due in part to the pioneering work of Ehrlich (1878), that targeted or localized drug delivery should be a major goal of chemotherapy. However, there is still only limited clinical use of nonsystemic intratumoral chemotherapy for even those high mortality cancers which are characterized by well defined primary lesions i.e. breast, colorectal, lung, prostate, and skin. There has been a proliferation of intratumoral chemotherapy and immunotherapy research during the past two to three years. It is therefore the objective of this review to focus much more attention upon intratumoral therapeutic concepts which could limit adverse systemic events and which might combine clinically feasible methods for localized preoperative chemotherapy and/or immunotherapy with surgery. Since our review of intratumoral chemoimmunotherapy almost 20 years ago (McLaughlin & Goldberg 1983), there have been few comprehensive reviews of this field; only one of broad scope (Brincker 1993), three devoted specifically to gliomas (Tomita 1991; Walter et al. 1995; Haroun & Brem 2000), one on hepatomas (Venook 2000), one concerning veterinary applications (Theon 1998), and one older review of dermatological applications (Goette 1981). However, none have shed light on practical opportunities for combining intratumoral therapy with subsequent surgical resection. Given the state-of-the-art in clinical and surgical oncology, and the advances that have been made in intratumoral drug delivery, minimally invasive tumour access i.e. fine needle biopsy, new drugs and drug delivery systems, and preoperative chemotherapy, it is timely to present a review of studies which may suggest future opportunities for safer, more effective, and clinically practical non-systemic therapy.
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Affiliation(s)
- Eugene P Goldberg
- Biomaterials Center, Department of Materials Science and Engineering, University of Florida, Gainesville 32611, USA.
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19
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Affiliation(s)
- P Gibbs
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado 80262, USA
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20
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Romagosa R, Saap L, Givens M, Salvarrey A, He JL, Hsia SL, Taylor JR. A pilot study to evaluate the treatment of basal cell carcinoma with 5-fluorouracil using phosphatidyl choline as a transepidermal carrier. Dermatol Surg 2000; 26:338-40. [PMID: 10759821 DOI: 10.1046/j.1524-4725.2000.99227.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND In certain situations, successful topical therapy of basal cell carcinoma (BCC) without the inconvenience, risk, and expense of surgery would be of great value to patients. Placing 5-fluorouracil (FU) in an appropriate carrier may solve these problems. Phosphatidyl choline (PC) penetrates effectively throughout the epidermis of shaved rabbits and may be able to carry small water-soluble molecules such as nucleotides across lipid barriers when applied topically. OBJECTIVE We propose that employing PC as a vehicle will facilitate the penetration of 5-FU and increase efficacy as compared to petrolatum-based 5-FU cream. METHODS This pilot study is a double-blinded and randomized therapeutic trial. Thirteen patients with 17 biopsy-proven, moderate thickness BCCs were randomized to receive either cream A (5% 5-FU in a PC vehicle) or cream B (Efudex(R): 5% 5-FU in a petrolatum base). Patients applied cream A or cream B twice a day for 4 weeks. The patients underwent an excisional biopsy of the treated BCC site at week 16. RESULTS There was a 90% cure rate (9/10) in those lesions treated with 5% 5-FU in PC cream and a 57% cure rate (4/7) in those treated with 5% 5-FU in a petrolatum-based cream. CONCLUSION Although the study was unable to detect any statistically significant differences in outcome between the study groups, this small pilot study shows preliminary findings which may indicate an increase in the short-term eradication of BCC using a PC-based vehicle as compared to conventional petrolatum-based formulations.
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Affiliation(s)
- R Romagosa
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida, USA
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21
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Abel EA. Skin neoplasias including cutaneous lymphoma, melanoma, and others: unapproved treatments or indications. Clin Dermatol 2000; 18:201-10. [PMID: 10742630 DOI: 10.1016/s0738-081x(99)00112-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- E A Abel
- Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA
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Affiliation(s)
- E A Abel
- Stanford University School of Medicine, California, USA
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23
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Abstract
The incidence of skin cancers is increasing at a rate greater than any other cancer occurring in humans. In this era of managed care, patients with a suspicious skin lesion may first present to their primary care physician for evaluation. Therefore, it is important for the primary care physician to be able to distinguish between benign and malignant pigmented lesions, to know how to evaluate such a patient, and to appreciate the importance of appropriate interdisciplinary management of these patients.
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Affiliation(s)
- M Hochman
- Department of Dermatology and Otolaryngology, Medical University of South Carolina, Charleston, USA
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Kraus S, Miller BH, Swinehart JM, Shavin JS, Georgouras KE, Jenner DA, Griffin E, Korey A, Orenberg EK. Intratumoral chemotherapy with fluorouracil/epinephrine injectable gel: a nonsurgical treatment of cutaneous squamous cell carcinoma. J Am Acad Dermatol 1998; 38:438-42. [PMID: 9520026 DOI: 10.1016/s0190-9622(98)70502-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND We attempted to originate a nonsurgical treatment alternative for cutaneous squamous cell carcinoma (SCC), and we evaluated intratumoral modified-release chemotherapy with fluorouracil/epinephrine injectable gel (5-FU/epi gel). OBJECTIVE To assess the safety and efficacy, we conducted an open-label pilot study of 5-FU/epi gel in 25 patients with biopsy-proven SCC lesions on the face, head, neck, trunk, arms, and hands. METHODS Each tumor site was injected intradermally with up to 1.0 ml of 5-FU/epi gel. One SCC per patient was treated weekly for up to 6 weeks, then observed for 4 months at which time the tumor site and margins were excised for histologic examination. RESULTS Overall, 96% (22 of 23) of evaluable treated tumors had histologically confirmed complete tumor clearing. No clinically significant systemic reactions or unexplained treatment-related adverse medical events occurred. The evaluations of the cosmetic appearance of the treated sites, judged subjectively by clinicians and patients, were mostly good to excellent and generally in close agreement. CONCLUSION Treatment of superficial SCC with 5-FU/epi injectable gel results in a high rate of histologically confirmed complete tumor responses and may provide a nonsurgical treatment alternative in selected patients.
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Affiliation(s)
- S Kraus
- Georgia Clinical Research Center, Inc., Atlanta, USA
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25
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Swinehart JM, Skinner RB, McCarty JM, Miller BH, Tyring SK, Korey A, Orenberg EK. Development of intralesional therapy with fluorouracil/adrenaline injectable gel for management of condylomata acuminata: two phase II clinical studies. Genitourin Med 1997; 73:481-7. [PMID: 9582466 PMCID: PMC1195930 DOI: 10.1136/sti.73.6.481] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate a sustained release chemotherapy for treating condylomata acuminata with an injectable gel containing fluorouracil and adrenaline (5-FU/adrenaline gel). Study 1-- To assess contributions of the components of 5-FU/adrenaline gel to efficacy. Study 2--To assess therapeutic contribution of adrenaline and safety and efficacy of the formulations. DESIGN Randomised, double blind, placebo controlled studies. SETTING Private practices and university clinics in the United States. PATIENTS Men and women with new, recurrent, or refractory external condylomata acuminata. INTERVENTION Six injections over 8 weeks; follow up visits at weeks 1, 4, 8, and 12. MAIN OUTCOME MEASURES EFFICACY patient/wart response, times to complete response, recurrence rates. SAFETY injection reactions, tissue conditions, other adverse events, laboratory studies. RESULTS Study 1: 132 evaluable patients. Complete response (CR) rate was highest for the 5-FU/adrenaline gel group, followed by the 5-FU/adrenaline solution group, then the 5-FU gel group. 5-FU, adrenaline, and the collagen gel vehicle (in the presence of 5-FU) significantly affected CR and strongly influenced time to CR. The effects of 5-FU and adrenaline were statistically significant. Cutaneous reactions were mild to moderate. Study 2: 187 evaluable patients. Patients treated with 5-FU/adrenaline gel had a significantly higher CR rate and lower cumulative 90 day recurrence rate than those treated with 5-FU gel without adrenaline. Treatments were generally well tolerated, with only three treatment related, serious adverse events. CONCLUSION 5-FU/adrenaline gel is safe and efficacious for treatment of condylomata acuminata, and when compared with individual or various combinations of components, this formulation provided the greatest therapeutic advantage.
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Glass LF, Jaroszeski M, Gilbert R, Reintgen DS, Heller R. Intralesional bleomycin-mediated electrochemotherapy in 20 patients with basal cell carcinoma. J Am Acad Dermatol 1997; 37:596-9. [PMID: 9344200 DOI: 10.1016/s0190-9622(97)70178-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND A new anticancer therapy, electrochemotherapy (ECT), has been introduced that entails exposing cancerous tissues to short pulses of electricity during chemotherapy. This enhances cell membrane permeability and has been shown to have potent antitumor effects in vitro in animal models and in several clinical trials, including nevoid basal cell carcinoma (BCC). OBJECTIVE We report the effects of ECT on 20 patients with primary BCC. METHODS Electrical pulses were delivered to 54 tumors after administration of intralesional bleomycin sulfate. RESULTS Complete responses were observed in 53 (98%), and in the majority of these (94%) after a single treatment. No recurrences have been recorded with a mean of 18 months of observation. CONCLUSION Although these are preliminary results, ECT appears to be an effective alternative to surgical excision for the treatment of primary BCC.
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MESH Headings
- Adult
- Aged
- Antibiotics, Antineoplastic/administration & dosage
- Antibiotics, Antineoplastic/therapeutic use
- Antimetabolites, Antineoplastic/administration & dosage
- Antimetabolites, Antineoplastic/therapeutic use
- Bleomycin/administration & dosage
- Bleomycin/therapeutic use
- Carcinoma, Basal Cell/drug therapy
- Carcinoma, Basal Cell/pathology
- Carcinoma, Basal Cell/surgery
- Cell Membrane Permeability/drug effects
- Cicatrix/pathology
- Electrodes, Implanted
- Erythema/pathology
- Follow-Up Studies
- Humans
- Injections, Intralesional
- Iontophoresis/instrumentation
- Iontophoresis/methods
- Middle Aged
- Needles
- Neoplasm Recurrence, Local
- Remission Induction
- Skin Neoplasms/drug therapy
- Skin Neoplasms/pathology
- Skin Neoplasms/surgery
- Skin Ulcer/pathology
- Stainless Steel
- Wound Healing
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Affiliation(s)
- L F Glass
- Department of Dermatology, University of South Florida College of Medicine, Tampa 33612, USA
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Miller BH, Shavin JS, Cognetta A, Taylor RJ, Salasche S, Korey A, Orenberg EK. Nonsurgical treatment of basal cell carcinomas with intralesional 5-fluorouracil/epinephrine injectable gel. J Am Acad Dermatol 1997; 36:72-7. [PMID: 8996264 DOI: 10.1016/s0190-9622(97)70328-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND To develop a nonsurgical treatment alternative for basal cell carcinomas (BCCs), we evaluated intralesional sustained-release chemotherapy with 5-fluorouracil/epinephrine injectable gel (5-FU/epi gel). OBJECTIVE To optimize the dose and treatment schedule, we compared the safety, tolerance, and efficacy of six treatment regimens of 5-FU/epi gel in patients with BCCs. METHODS Two doses and four treatment schedules of 5-FU/epi gel were compared in an open-label, randomized study of 122 patients with biopsy-proven BCCs. One BCC per patient was treated for up to 4 to 6 weeks, then observed for 3 months at which time the tumor site was completely excised for histologic examination. RESULTS Overall, 91% of evaluable treated tumors (106 of 116) in all regimens had histologically confirmed complete tumor resolution. No clinically significant treatment-related systemic adverse events occurred. The best response rate, tolerance, and patient compliance with assigned dose were in patients receiving 0.5 ml of 5-FU/epi gel three times a week for 2 weeks. The complete response rate based on histologic assessment in this group was 100%. CONCLUSION Results demonstrate that treatment of BCC with 5-FU/epi gel is both safe and effective, may result in histologically confirmed complete response rates comparable to surgery, and provides a nonsurgical treatment alternative in selected patients.
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Affiliation(s)
- B H Miller
- Dermatology Service, University of Arizona Health Sciences Center, USA
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28
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Glass LF, Fenske NA, Jaroszeski M, Perrott R, Harvey DT, Reintgen DS, Heller R. Bleomycin-mediated electrochemotherapy of basal cell carcinoma. J Am Acad Dermatol 1996; 34:82-6. [PMID: 8543699 DOI: 10.1016/s0190-9622(96)90838-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A new technique, electroporation, enhances the antitumor effects of a variety of chemotherapeutic agents. When used in combination with conventional chemotherapy, the procedure is termed electrochemotherapy. Exposure of cancerous tissues to pulses of electricity during electrochemotherapy appears to increase cell membrane permeability and thus intracellular access to cytotoxic drugs. Electrochemotherapy has been shown to have potent antitumor activity in a variety of in vitro studies, animal tumor models, as well as in clinical trials with squamous cell carcinomas of the head and neck. OBJECTIVE The purpose of the study was to determine the effects of bleomycin-mediated electrochemotherapy on several basal cell carcinomas (BCCs) in two patients with nevoid BCC syndrome. METHODS Electrical pulses were delivered to tumor nodules by means of caliper electrodes after systemic doses of bleomycin were administered. Vital signs were closely monitored during application of the electrical pulses. RESULTS Partial responses were observed in tumors from both of the patients treated with electrochemotherapy; three partial responses were observed in one patient, and one partial response was observed in the other patient. Complete responses were seen in two lesions. Only minimal local or systemic side effects were noted in response to the therapy. CONCLUSION To our knowledge, this is the first study that documents the effects of bleomycin-mediated electrochemotherapy on BCC. Studies are ongoing with intralesional bleomycin during electrochemotherapy to see whether additional antitumour effects can be produced in patients with BCC by this route of administration.
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Affiliation(s)
- L F Glass
- Department of Internal Medicine, University of South Florida College of Medicine, Tampa, USA
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29
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Kitchell BK, Orenberg EK, Brown DM, Hutson C, Ray K, Woods L, Luck E. Intralesional sustained-release chemotherapy with therapeutic implants for treatment of canine sun-induced squamous cell carcinoma. Eur J Cancer 1995; 31A:2093-8. [PMID: 8562171 DOI: 10.1016/0959-8049(95)00446-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Squamous cell carcinoma (SCC) is the most frequently reported malignant epithelial tumour in dogs. Canine sun-induced SCC represents a useful animal model to evaluate new therapeutic modalities for possible human applications. We evaluated the safety and efficacy of treating sun-induced SCC in dogs with intralesional sustained-released chemotherapeutic gel implants that contained collagen, epinephrine (epi), and either 5-fluorouracil (5-FU) or cisplatin (CDDP). Dogs with large, single SCC or fields of multiple SCC were treated with 5-FU/epi gel for a minimum of three weekly injections. Dogs without a complete response were then treated with CDDP/epi gel for a minimum of three weekly treatments. We treated from one to 11 primary, recurrent, or refractory SCC per dog (tumour size 0.2-92.4 cm2; mean cumulative tumour area of 40.7 cm2 per dog). All dogs had at least 50% reduction in cumulative tumour area after treatment with 5-FU/epi gel. More than half (seven of 13) had complete resolution of SCC after treatment with 5-FU/epi gel or CDDP/epi gel. Minimal local tissue reactions were noted; no systemic toxicity occurred. Sustained-release chemotherapy using intralesional 5-FU/epi gel and CDDP/epi gel therapeutic implants is effective in treating canine sun-induced SCC of the skin.
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Affiliation(s)
- B K Kitchell
- Special Veterinary Services, Berkeley, California, USA
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30
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Yu NY, Orenberg EK, Luck EE, Brown DM. Antitumor effect of intratumoral administration of fluorouracil/epinephrine injectable gel in C3H mice. Cancer Chemother Pharmacol 1995; 36:27-34. [PMID: 7720172 DOI: 10.1007/bf00685728] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Fluorouracil/epinephrine injectable gel (5-FU/epi gel) was evaluated in vitro for its drug-release profile characteristics and in a mouse tumor model for its antitumor effectiveness. In vitro chemosensitivity studies with 5-FU in RIF-1 fibrosarcoma cells showed less than 1 log of cell kill at 1 mM after 2 h of exposure. Increasing the exposure time to 24 h resulted in greater cell killing (approximately 2.5 log cell kill at 0.5 mM), suggesting that sustained drug levels in tumors would result in an increased efficacy outcome in vivo. A 5-FU/epi injectable gel was designed, providing drug release in vitro of 50% by approximately 4 h and of 80% by 24 h. The retention of 5-FU in RIF-1 mouse tumors was determined after intratumoral administration of 5-FU/epi gel or various combinations of the formulation components. Area-under-the-curve (AUC0-24 h) calculations resulted in an AUC value of 146.4% h for the 5-FU/epi gel formulation as compared with 45.7% h for 5-FU solution. Tumor growth was significantly delayed (P < 0.05) with the 5-FU/epi gel (60 mg/kg) as compared with 5-FU solution given intratumorally or systemically. A fluorouracil dose of 150 mg/kg in the 5-FU/epi gel given weekly for 13 weeks was not lethally toxic, whereas the same dose given as drug solution was 100% lethal, suggesting that the therapeutic index for 5-FU in the gel formulation may be much greater than that for aqueous drug solution delivered intratumorally.
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Affiliation(s)
- N Y Yu
- Matrix Pharmaceutical, Inc., Menlo Park, CA 94025, USA
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31
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Affiliation(s)
- R A Kempf
- USC-Norris Cancer Center, Los Angeles 90033, USA
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32
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Abstract
A critical review is presented on a novel method of treating cancer by a combination of an electric field with chemotherapeutic agents. The work described here summarizes the current state of the technique known as electrical impulse chemotherapy (EIC) or electrochemotherapy (ECT). The review discusses in vitro results with specific cell lines, in vivo work on animals and clinical results on patients with squamous cell carcinomas of the head and neck. In all cases, it has been found that uptake of various drugs by the tumor cells can be increased markedly by EIC/ECT. Partial responses and complete cures have been observed without any damaging side-effects, provided the field strength is kept sufficiently low. ECT followed by injection of a low dose of interleukin-2 (IL-2) or IL-2 secreting cells has shown better results than ECT alone. There appears to be a systemic effect and a strong indication that an immune response may be elicited by this method of treatment. Finally, we discuss the challenges involved in hardware requirements for EIC/ECT and its future prospects for both drug delivery and gene therapy.
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Affiliation(s)
- S B Dev
- BTX, Inc., San Diego, CA 92121-1334
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33
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Abstract
This article reviews therapeutic studies reported in the English-language literature during 1992. Readers should review the original article in full before attempting any experimental or controversial therapy.
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Affiliation(s)
- R J Coskey
- Dermatology Department, Wayne State University School of Medicine
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