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Min JWS, Saeed N, Coene A, Adriaens M, Ceelen W. Electromotive Enhanced Drug Administration in Oncology: Principles, Evidence, Current and Emerging Applications. Cancers (Basel) 2022; 14:4980. [PMID: 36291762 PMCID: PMC9599758 DOI: 10.3390/cancers14204980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/05/2022] [Accepted: 10/08/2022] [Indexed: 08/30/2023] Open
Abstract
Local-regional administration of cytotoxic drugs is an important adjunct to systemic chemotherapy amongst cancer patients. It allows for targeted delivery of agents at high concentration to target sites while minimizing systemic side effects. Despite the pharmacokinetic advantages of the local-regional approach, drug transport into tumor nodules remains limited due to the biophysical properties of these tissues. Electromotive enhanced drug administration (EMDA) represents a potential solution to overcome challenges in local drug transport by applying electric currents. Through electrokinetic phenomena of electromigration, electroosmosis and electroporation, electric currents have been shown to improve drug penetration and distribution in a wide variety of clinical applications. Amongst patients with non-muscular invasive bladder cancer (NMIBC) and basal and squamous cell skin cancers, EMDA has been successfully adopted and proven efficacious in several pre-clinical and clinical studies. Its application in ophthalmological and other conditions has also been explored. This review provides an overview of the underlying principles and factors that govern EMDA and discusses its application in cancer patients. We also discuss novel EMDA approaches in pre-clinical studies and explore future opportunities of developments in this field.
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Affiliation(s)
- Jolene Wong Si Min
- Department of GI Surgery, Ghent University Hospital, 9000 Ghent, Belgium
| | - Nidda Saeed
- Department of GI Surgery, Ghent University Hospital, 9000 Ghent, Belgium
| | - Annelies Coene
- Department of Electromechanical, Systems and Metal Engineering, Faculty of Engineering and Architecture, Ghent University, 9000 Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), 9000 Ghent, Belgium
| | - Mieke Adriaens
- Department of Chemistry, Faculty of Sciences, Ghent University, 9000 Ghent, Belgium
| | - Wim Ceelen
- Department of GI Surgery, Ghent University Hospital, 9000 Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), 9000 Ghent, Belgium
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2
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Yamada M, Prow TW. Physical drug delivery enhancement for aged skin, UV damaged skin and skin cancer: Translation and commercialization. Adv Drug Deliv Rev 2020; 153:2-17. [PMID: 32339593 DOI: 10.1016/j.addr.2020.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/31/2020] [Accepted: 04/22/2020] [Indexed: 01/31/2023]
Abstract
This review analyses physical drug delivery enhancement technologies with a focus on improving UV damaged skin, actinic keratoses and non-melanoma skin cancer treatment. In recent years, physical drug delivery enhancement has been shown to enhance cosmeceutical and skin cancer treatment efficacy, but there are pros and cons to each approach which we discuss in detail. Mechanisms of action, clinical efficacy, experimental design, outcomes in academic publications, clinical trial reports and patents are explored to evaluate each technology with a critical, translation focused lens. We conclude that the commercial success of cosmeceutical applications, e.g. microneedles, will drive further innovation in this arena that will impact how actinic keratoses and non-melanoma skin cancers are clinically managed.
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3
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Selected Medicines Used in Iontophoresis. Pharmaceutics 2018; 10:pharmaceutics10040204. [PMID: 30366360 PMCID: PMC6320882 DOI: 10.3390/pharmaceutics10040204] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/17/2018] [Accepted: 10/24/2018] [Indexed: 12/26/2022] Open
Abstract
Iontophoresis is a non-invasive method of systemic and local drug delivery using an electric field. Iontophoresis enables diffusion of the selected drug via skin, mucosa, enamel, dentin, and other tissues. The amount of delivered therapeutic molecules is about 10⁻2000 times greater than conventional forms of delivery. Among other fields, this method is used in dentistry, ophthalmology, otorhinolaryngology, and dermatology. According to related literature, the most important drugs studied or administered by iontophoresis are: Local anesthetics, opioids, steroids, non-steroidal anti-inflammatory drugs, antibacterial drugs, antifungal drugs, antiviral drugs, anticancer drugs, fluorides, and vitamins. The present review covers current available data regarding the selected medicines used in iontophoresis. Furthermore, indications and conditions of iontophoresis application are reviewed.
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4
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Byrne JD, Yeh JJ, DeSimone JM. Use of iontophoresis for the treatment of cancer. J Control Release 2018; 284:144-151. [PMID: 29908892 DOI: 10.1016/j.jconrel.2018.06.020] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/14/2018] [Accepted: 06/14/2018] [Indexed: 01/30/2023]
Abstract
Despite major advancements in cancer treatments, there are still many limitations to therapy including off-target effects, drug resistance, and control of cancer-related symptoms. There are opportunities for local drug delivery devices to intervene at various stages of cancer to provide curative and palliative benefit. Iontophoretic devices that deliver drugs locally to a region of interest have been adapted for the treatment of cancer. These devices have shown promise in pre-clinical and clinical studies for retinoblastoma, skin, bladder, and pancreatic cancers. Herein, we review iontophoretic devices used in the management of cancer.
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Affiliation(s)
- James D Byrne
- Harvard Radiation Oncology Program, Boston, MA 02114, USA.
| | - Jen Jen Yeh
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Division of Surgical Oncology, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Joseph M DeSimone
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Chemical and Biomolecular Engineering, North Carolina State University, Raleigh, NC 27695, USA
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5
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Abstract
Background: Bowen's disease is a common skin cancer. There are many different therapeutic approaches to treatment. Topical 5-Fluorouracil (5-FU) cream has been used for many years and there are many published papers attesting to its effectiveness. However, no papers have presented long-term followup results with biopsy confirmation of cure. Objectives: The purpose of this article is to present the long-term findings following the use of this cream in the treatment of Bowen's disease. Methods: Twenty-four patients with 26 biopsy-confirmed lesions of Bowen's disease were treated with topical 5-Fluorouracil cream and were followed for periods of up to 10 years. Posttreatment biopsies were performed in most cases. Results: Two of the 26 lesions treated topically recurred at some point. The rest were apparently cured. Conclusion: The results presented in this article confirm that treatment of Bowen's disease with topical 5-Fluorouracil cream is safe and effective treatment.
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Affiliation(s)
- Howard Bargman
- Division of Dermatology, Sunnybrook and Women's Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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6
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Byrne JD, Jajja MRN, O'Neill AT, Bickford LR, Keeler AW, Hyder N, Wagner K, Deal A, Little RE, Moffitt RA, Stack C, Nelson M, Brooks CR, Lee W, Luft JC, Napier ME, Darr D, Anders CK, Stack R, Tepper JE, Wang AZ, Zamboni WC, Yeh JJ, DeSimone JM. Local iontophoretic administration of cytotoxic therapies to solid tumors. Sci Transl Med 2015; 7:273ra14. [PMID: 25653220 DOI: 10.1126/scitranslmed.3009951] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Parenteral and oral routes have been the traditional methods of administering cytotoxic agents to cancer patients. Unfortunately, the maximum potential effect of these cytotoxic agents has been limited because of systemic toxicity and poor tumor perfusion. In an attempt to improve the efficacy of cytotoxic agents while mitigating their side effects, we have developed modalities for the localized iontophoretic delivery of cytotoxic agents. These iontophoretic devices were designed to be implanted proximal to the tumor with external control of power and drug flow. Three distinct orthotopic mouse models of cancer and a canine model were evaluated for device efficacy and toxicity. Orthotopic patient-derived pancreatic cancer xenografts treated biweekly with gemcitabine via the device for 7 weeks experienced a mean log2 fold change in tumor volume of -0.8 compared to a mean log2 fold change in tumor volume of 1.1 for intravenous (IV) gemcitabine, 3.0 for IV saline, and 2.6 for device saline groups. The weekly coadministration of systemic cisplatin therapy and transdermal device cisplatin therapy significantly increased tumor growth inhibition and doubled the survival in two aggressive orthotopic models of breast cancer. The addition of radiotherapy to this treatment further extended survival. Device delivery of gemcitabine in dogs resulted in more than 7-fold difference in local drug concentrations and 25-fold lower systemic drug levels than the IV treatment. Overall, these devices have potential paradigm shifting implications for the treatment of pancreatic, breast, and other solid tumors.
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Affiliation(s)
- James D Byrne
- Division of Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Mohammad R N Jajja
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Adrian T O'Neill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Lissett R Bickford
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Amanda W Keeler
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Nabeel Hyder
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kyle Wagner
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Allison Deal
- Lineberger Comprehensive Cancer Center Biostatistics and Clinical Data Management Core, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Ryan E Little
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Richard A Moffitt
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Colleen Stack
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. School of Medicine, Duke University, Durham, NC 27708, USA. Synecor LLC, Chapel Hill, NC 27517, USA
| | - Meredith Nelson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Christopher R Brooks
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - William Lee
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - J Chris Luft
- Division of Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Mary E Napier
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - David Darr
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Carey K Anders
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Richard Stack
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. Synecor LLC, Chapel Hill, NC 27517, USA. Division of Cardiology, Department of Medicine, Duke University, Durham, NC 27708, USA
| | - Joel E Tepper
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Andrew Z Wang
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - William C Zamboni
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jen Jen Yeh
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. Division of Surgical Oncology, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Joseph M DeSimone
- Division of Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. Department of Chemical and Biomolecular Engineering, North Carolina State University, Raleigh, NC 27695, USA.
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7
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Kallini JR, Hamed N, Khachemoune A. Squamous cell carcinoma of the skin: epidemiology, classification, management, and novel trends. Int J Dermatol 2014; 54:130-40. [PMID: 25428226 DOI: 10.1111/ijd.12553] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Squamous cell carcinoma (SCC) is the second most common non-melanoma skin cancer. It originates from epidermal keratinocytes or adnexal structures (such as eccrine glands or pilosebaceous units). We describe the salient features of cutaneous SCC. We also review novel classification schemes proposed during the last decade which attempt to stratify SCC lesions based on prognosis. Biopsy leads to definitive diagnosis. Treatment includes surgical excision; Mohs micrographic surgery produces excellent cure rates and spares the maximal amount of tissue. Other modalities include electrodessication and curettage, cryosurgery, radiotherapy, topical medications, photodynamic therapy, and systemic therapy. Management and follow-up depend on the risk stratification of individual lesions.
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Affiliation(s)
- Joseph R Kallini
- Department of Internal Medicine, Eisenhower Medical Center, Rancho Mirage, CA, USA; School of Medicine, Baylor College of Medicine, Houston, TX, USA
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Khandpur S, Sharma VK. Successful Treatment of Multiple Premalignant and Malignant Lesions in Arsenical Keratosis with a Combination of Acitretin and Intralesional 5-Fluorouracil. J Dermatol 2014; 30:730-4. [PMID: 14684956 DOI: 10.1111/j.1346-8138.2003.tb00468.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2003] [Accepted: 06/10/2003] [Indexed: 11/30/2022]
Abstract
A case of arsenical keratosis with multiple lesions of Bowen's disease and squamous cell carcinoma is described. The patient was successfully treated with a combination of acitretin and intralesional 5-fluorouracil. All the lesions resolved after three months of therapy with no side effects and no recurrence during four months of follow-up.
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Affiliation(s)
- Sujay Khandpur
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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9
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Morton CA, Birnie AJ, Eedy DJ. British Association of Dermatologists' guidelines for the management of squamous cell carcinoma in situ (Bowen's disease) 2014. Br J Dermatol 2014; 170:245-60. [PMID: 24313974 DOI: 10.1111/bjd.12766] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2013] [Indexed: 01/14/2023]
Affiliation(s)
- C A Morton
- Stirling Community Hospital, Stirling, FK8 2AU, U.K
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10
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Lallas A, Argenziano G, Zendri E, Moscarella E, Longo C, Grenzi L, Pellacani G, Zalaudek I. Update on non-melanoma skin cancer and the value of dermoscopy in its diagnosis and treatment monitoring. Expert Rev Anticancer Ther 2013; 13:541-58. [PMID: 23617346 DOI: 10.1586/era.13.38] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Dermoscopy has become an integrative part of the clinical examination of skin tumors. This is because it significantly improves the early diagnosis of melanoma and non-melanoma skin cancer (NMSC) including basal cell carcinoma and keratinocyte skin cancer compared with the unaided eye. Besides its value in the noninvasive diagnosis of skin cancer, dermoscopy has also gained increased interest in the management of NMSC. Dermoscopy has been used in the preoperative evaluation of tumor margins, monitoring of the outcomes of topical treatments and post-treatment follow-up. This article provides an update on NMSC with special emphasis on dermoscopy in the diagnosis and management of basal cell carcinoma, actinic keratosis, Bowens' disease and squamous cell carcinoma.
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Affiliation(s)
- Aimilios Lallas
- Skin Cancer Unit, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Viale Risorgimento 80, 42100 Reggio Emilia, Italy
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11
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Gratieri T, Wagner B, Kalaria D, Ernst B, Kalia YN. Cutaneous iontophoretic delivery of CGP69669A, a sialyl Lewisx mimetic, in vitro. Exp Dermatol 2012; 21:226-8. [DOI: 10.1111/j.1600-0625.2011.01429.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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13
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Prstojevich SJ, Nierzwicki BL. Treatment options for premalignant and malignant cutaneous tumors. Oral Maxillofac Surg Clin North Am 2007; 17:147-60, v. [PMID: 18088774 DOI: 10.1016/j.coms.2005.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Whenever possible, surgical excision of skin cancers should be the gold standard of treatment. There are many considerations when choosing one treatment modality over another. These include the lesion's location, the surgeon's experience and comfort level, the patient's health status and their potential compliance, access to available technology, and economic considerations for the patient and the provider. Regardless of the type of therapy, all forms of treatment share the following goals: complete disease cure, preservation of normal tissue, preservation of function, and optimal cosmesis.
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Affiliation(s)
- Steven J Prstojevich
- Department of Oral and Maxillofacial Surgery, University of Missouri-Kansas City, Truman Medical Center, 2301 Holmes Street, Kansas City, MO 64108, USA.
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14
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Abstract
Multiple therapeutic options are available for treatment of Bowen's disease. The choice of therapy depends on clinical circumstance and medical practitioner experience. Newer therapies have more extensive support from the literature, but more established therapies may be preferred because of accessibility, cost and efficacy. An overview of the current therapeutic options for Bowen's disease is presented.
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Affiliation(s)
- Gilberto Moreno
- St George Dermatology and Skin and Cancer Centre, Kogarah, New South Wales, Australia
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15
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Abstract
This article represents a planned regular updating of the previous British Association of Dermatologists (BAD) guidelines for management of Bowen's disease. They have been prepared for dermatologists on behalf of the BAD. They present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines.
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Affiliation(s)
- N H Cox
- Craigavon Area Hospital, Craigavon BT63 5QQ, U.K.
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16
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Murray AK, Herrick AL, Gorodkin RE, Moore TL, King TA. Possible therapeutic use of vasodilator iontophoresis. Microvasc Res 2005; 69:89-94. [PMID: 15797265 DOI: 10.1016/j.mvr.2005.01.005] [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] [Received: 10/29/2004] [Indexed: 11/20/2022]
Abstract
BACKGROUND Investigation into the effects of a novel vasodilator delivery method (for the eventual treatment of scleroderma related digital ulceration) on healthy controls is reported. When Raynaud's phenomenon (episodic cold-induced colour changes of the fingers) occurs in the context of scleroderma, it can be extremely severe, leading to ulceration and sometimes gangrene. The current treatment of choice for scleroderma-related critical digital ischaemia and/or ulceration is intravenous prostanoid therapy, necessitating hospitalisation. However, iloprost is often poorly tolerated and may be ineffective. METHODS This study utilises a newly designed iontophoresis chamber which has the potential to allow a therapeutic, rather than diagnostic application for vasodilatory iontophoresis. Ten healthy controls underwent whole finger iontophoresis with 1% acetylcholine chloride for 2 min at 100 microA. Iontophoresis with varying treatment times and currents was carried out on a subset of subjects to determine the effect on perfusion increase. RESULTS A significant increase in perfusion following iontophoresis was found, compared to the adjacent, untreated finger (P < 0.001). Maximum increase as a percentage from baseline, mean [SD] = 100 [66]%. Both treatment time and current have an approximately linear relationship with perfusion increase. CONCLUSIONS Iontophoresis of the whole finger administers drugs locally with no systemic effects and warrants further investigation as a therapy.
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Affiliation(s)
- Andrea K Murray
- Department of Physics and Astronomy, Laser Photonics Group, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
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17
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Liu GT, Lovell MO, Steinberg JS. Digital syndactylization for the treatment of interdigital squamous cell carcinoma in situ (Bowen disease). J Foot Ankle Surg 2004; 43:419-22. [PMID: 15605056 DOI: 10.1053/j.jfas.2004.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Bowen disease, or squamous cell carcinoma in situ, has been described as a premalignant intraepidermal lesion of the skin. Although more frequently occurring on limbs, interdigital presentation of squamous cell carcinoma in situ in the foot has been rarely reported, likely because of undetected development. Excision has been recommended as the treatment of choice; however, removal of these lesions from intertriginous skin may present few options for skin closure. Interdigital syndactylization may be an acceptable option for the treatment of interdigital manifestations of Bowen disease. The authors present a case of interdigital squamous cell carcinoma in situ successfully treated with excision and digital syndactylization. At the 2-year follow-up, there was no recurrence and no digital deformities.
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Affiliation(s)
- George T Liu
- Division of Podiatry, Department of Orthopaedics, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
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18
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McGillis ST, Fein H. Topical treatment strategies for non-melanoma skin cancer and precursor lesions. ACTA ACUST UNITED AC 2004; 23:174-83. [PMID: 15584683 DOI: 10.1016/j.sder.2004.06.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The ability to manage non-melanoma skin cancers and pre-malignant lesions with topical pharmacologic agents is highly compelling. This article examines currently available products and discusses their emerging roles and limitations. These include fluorouracil, diclofenac sodium, imiquimod, and photodynamic therapy.
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Affiliation(s)
- S Teri McGillis
- Department of Dermatology, Section of Dermatologic Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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19
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Ammirati CT, Ioffreda MD, Hruza GJ. Malignant tumors of the keratinocytes and adnexae. Facial Plast Surg Clin North Am 2004; 11:141-63. [PMID: 15062270 DOI: 10.1016/s1064-7406(02)00042-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Christie T Ammirati
- Department of Dermatology, Pennsylvania State University, Milton S. Hershey Medical Center, 500 University Drive, PO Box 850, Hershey, PA 17033, USA.
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20
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Kalia YN, Naik A, Garrison J, Guy RH. Iontophoretic drug delivery. Adv Drug Deliv Rev 2004; 56:619-58. [PMID: 15019750 DOI: 10.1016/j.addr.2003.10.026] [Citation(s) in RCA: 490] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2003] [Accepted: 10/13/2003] [Indexed: 01/23/2023]
Abstract
The composition and architecture of the stratum corneum render it a formidable barrier to the topical and transdermal administration of therapeutic agents. The physicochemical constraints severely limit the number of molecules that can be considered as realistic candidates for transdermal delivery. Iontophoresis provides a mechanism to enhance the penetration of hydrophilic and charged molecules across the skin. The principal distinguishing feature is the control afforded by iontophoresis and the ability to individualize therapies. This may become significant as the impact of interindividual variations in protein expression and the effect on drug metabolism and drug efficacy is better understood. In this review we describe the underlying mechanisms that drive iontophoresis and we discuss the impact of key experimental parameters-namely, drug concentration, applied current and pH-on iontophoretic delivery efficiency. We present a comprehensive and critical review of the different therapeutic classes and molecules that have been investigated as potential candidates for iontophoretic delivery. The iontophoretic delivery of peptides and proteins is also discussed. In the final section, we describe the development of the first pre-filled, pre-programmed iontophoretic device, which is scheduled to be commercialized during the course of 2004.
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21
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Wang KH, Fang JY, Hu CH, Lee WR. Erbium:YAG Laser Pretreatment Accelerates the Response of Bowen's Disease Treated by Topical 5-Fluorouracil. Dermatol Surg 2004; 30:441-5. [PMID: 15008880 DOI: 10.1111/j.1524-4725.2004.30122.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Topical 5-fluorouracil (5-FU) is a standard treatment for Bowen's disease. However, its efficacy may be limited by the presence of stratum corneum. The Er:YAG laser has shown a dramatic enhancement effect on the delivery of 5-FU in vitro by ablation of the stratum corneum. The efficacy of laser-assisted delivery of 5-FU has not been tested in human. OBJECTIVE To see whether Er:YAG laser pretreatment can improve the efficacy of topical 5-FU in the treatment of Bowen's disease. METHODS Three target lesions from a patient with multiple Bowen's disease were selected for a half-side comparison study. The Er:YAG laser was used to remove the cornified layer on one side of each lesion, followed by twice-daily application of 5-FU cream to both sides. Clinical and histologic responses were compared. RESULTS Lesions pretreated with the Er:YAG laser showed more rapid clinical and histologic responses to topical 5-FU than those treated with 5-FU alone. Evaluation at 9 months after treatment showed no recurrences of lesions on both sides. CONCLUSIONS Our preliminary study demonstrates that this Er:YAG laser-assisted modality is effective and shows accelerated clinical response and shortened treatment time compared with topical 5-FU as a single treatment.
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Affiliation(s)
- Kuo-Hsien Wang
- Department of Dermatology, Taipei Municipal Wan-Fang Hospital, Taipei, Taiwan
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22
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WANG KUOHSIEN, FANG JIAYOU, HU CHUNGHONG, LEE WOANRUOH. Erbium: YAG Laser Pretreatment Accelerates the Response of Bowenʼs Disease Treated by Topical 5-Fluorouracil. Dermatol Surg 2004. [DOI: 10.1097/00042728-200403000-00027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Morse LG, Kendrick C, Hooper D, Ward H, Parry E. Treatment of squamous cell carcinoma with intralesional 5-Fluorouracil. Dermatol Surg 2004; 29:1150-3; discussion 1153. [PMID: 14641346 DOI: 10.1046/j.1524-4725.2003.29355.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND 5-Fluorouracil (5-FU) has been used topically and intralesionally to treat lesions related to squamous cell carcinoma (SCC) such as actinic keratosis, Bowen's disease, and keratoacanthoma. OBJECTIVE We sought to determine whether intralesional 5-FU might be effective in treating a patient with SCC. METHODS A patient with SCC at the junction of the right alar crease and right nasolabial fold was treated with eight weekly injections of 5-FU, with doses ranging from 0.8 to 2.4 mL. RESULTS A repeat biopsy after the eighth treatment showed total clearance of the cancer, and the patient has remained free of recurrence during a 5-month follow-up period. CONCLUSION This modality may provide patients with SCC in cosmetically important locations or in areas that require complex surgery the advantage of a nonsurgical cure.
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Affiliation(s)
- Lisa G Morse
- Department of Dermatology, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA 70112, USA
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24
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Treatment of Squamous Cell Carcinoma With Intralesional 5-Fluorouracil. Dermatol Surg 2003. [DOI: 10.1097/00042728-200311000-00018] [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]
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25
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Richter ON, Petrow W, Wardelmann E, Dorn C, Kupka M, Ulrich U. Bowenoid papulosis of the vulva-immunotherapeutical approach with topical imiquimod. Arch Gynecol Obstet 2003; 268:333-6. [PMID: 14504882 DOI: 10.1007/s00404-002-0385-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2002] [Accepted: 07/08/2002] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Bowenoid papulosis is a characteristic lesion of the ano-genital region and represents a form of squamous cell carcinoma in situ, very often associated to the oncogenic high-risk human papilloma virus (HPV) types 16, 18, 31 and 33. Therapies applied so far, in general, show high rates of relapse, and patients complain of pruritus and pain. Imiquimod cream is a topical immune response modifier with indirect antiviral and antitumor effects through the stimulation of local cytokine production and cell-mediated immune response. CASE REPORT In the present paper we report on the topical application of imiquimod cream in a woman with a high-risk HPV-associated vulvar intraepithelial neoplasia grade III (VIN III) of the vulva. DISCUSSION In addition a review of the literature is given.
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Affiliation(s)
- O N Richter
- Department of Obstetrics and Gynecology, University of Bonn School of Medicine, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany.
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26
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Mackenzie-Wood A, Kossard S, de Launey J, Wilkinson B, Owens ML. Imiquimod 5% cream in the treatment of Bowen's disease. J Am Acad Dermatol 2001; 44:462-70. [PMID: 11209116 DOI: 10.1067/mjd.2001.111335] [Citation(s) in RCA: 212] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Large-diameter lesions of Bowen's disease at sites such as the shin may be difficult to treat surgically and may require alternate treatment modalities. OBJECTIVE We investigated whether imiquimod 5% cream, a topical immune response modifier that stimulates the production of interferon alfa and other cytokines, is an effective topical treatment for Bowen's disease. METHODS This was a phase II, open-label study in 16 patients, treating a single biopsy-proven plaque of Bowen's disease that was 1 cm or larger in diameter, with once-daily self-application of imiquimod 5% cream for 16 weeks. A biopsy was performed on the treated area 6 weeks after the end of treatment, with patient follow-up at 3 and 6 months. Lymphocyte CD4/CD8 ratios were analyzed in pretreatment and posttreatment biopsy specimens by immunophenotyping the lymphocytic infiltrate. RESULTS Sixteen patients with Bowen's disease lesions ranging from 1 to 5.4 cm in diameter (0.7-21.6 cm(2) in area) were treated. Fifteen of these lesions were on the legs, and one was on the shoulder. Fourteen of the 15 patients (93% per protocol analysis) had no residual tumor present in their 6-week posttreatment biopsy specimens. One patient died of unrelated intercurrent illness before a biopsy specimen could be obtained. The median CD4/CD8 lymphocyte ratio in pretreatment biopsy specimens was 2:1, and this was reversed to a median of 1:2.2 in the posttreatment specimens. Ten patients completed 16 weeks of treatment, but 6 patients ceased treatment early (between 4 and 8 weeks) because of local skin reactions. CONCLUSION Imiquimod 5% cream appears to be an effective treatment for Bowen's disease on the lower limbs. The 93% positive treatment response in biopsy-proven cases (excludes patient who died from an intercurrent illness who did not undergo a posttreatment biopsy) compares favorably with other current treatment modalities. The dosing schedule and length of treatment for Bowen's disease require further evaluation.
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27
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Cox NH, Eedy DJ, Morton CA. Guidelines for management of Bowen's disease. British Association of Dermatologists. Br J Dermatol 1999; 141:633-41. [PMID: 10583109 DOI: 10.1046/j.1365-2133.1999.03100.x] [Citation(s) in RCA: 137] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
These guidelines for management of Bowen's disease have been prepared for dermatologists on behalf of the British Association of Dermatologists. They present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and investigation.
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Affiliation(s)
- N H Cox
- Department of Dermatology, Cumberland Infirmary, Carlisle, CA2 7HY, U.K
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28
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Meidan VM, Walmsley AD, Docker MF, Irwin WJ. Ultrasound-enhanced diffusion into coupling gel during phonophoresis of 5-fluorouracil. Int J Pharm 1999; 185:205-13. [PMID: 10460916 DOI: 10.1016/s0378-5173(99)00168-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate the competitive transport across skin and back-diffusion of 5-fluorouracil into coupling gel under the influence of ultrasound, heat-alone and Azone enhancement. METHODS The ultrasound effect on 5-fluorouracil penetration through whole rat skin was investigated in modified diffusion cells using a commercial ultrasound generator which was calibrated with a bilaminar membrane hydrophone. RESULTS Ultrasonic dosimetry measurements demonstrated that the skin membrane was subjected to a complex and unpredictable standing wave field which induced physiologically acceptable heating of the tissue. Surprisingly, ultrasonication produced a decrease in percutaneous drug penetration. Quantification studies indicated that this effect was due to the diffusive loss of the hydrophilic substance 5-fluorouracil from the skin surface into the overlying volume of coupling gel. This phenomenon could be duplicated by the application of conductive heating, indicating that the thermal effects of ultrasound were probably responsible for accelerated 5-fluorouracil diffusion through the gel. CONCLUSION This study acutely demonstrates how formulation design of the donor vehicle/coupling gel may radically affect therapeutic efficacy in phonophoretic systems.
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Affiliation(s)
- V M Meidan
- Pharmaceutical Sciences Research Institute, Aston Pharmacy School, Aston University, Aston Triangle, Birmingham, UK
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29
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Ball SB, Dawber RP. Treatment of cutaneous Bowen's disease with particular emphasis on the problem of lower leg lesions. Australas J Dermatol 1998; 39:63-8; quiz 69-70. [PMID: 9611372 DOI: 10.1111/j.1440-0960.1998.tb01250.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Bowen's disease has a particular predilection for the lower leg, especially in women. A review of the literature for treating Bowen's disease is presented and the problems associated with treating the lower leg emphasized. Evidence for the various treatment modalities used to treat Bowen's disease largely comes from studies that lack good methodology in terms of standardized techniques, patient controls and adequate follow-up. In particular the widely accepted recommendation for excision is not supported by evidence that this treatment is superior to other modalities. The choice of treatment for Bowen's disease should take into account the patient's general condition, the site and size of the lesion.
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Affiliation(s)
- S B Ball
- Department of Dermatology, Oxford Radcliffe Hospital, United Kingdom
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