Tra i diversi approcci per il trattamento di tumori cutanei vi è il trattamento con Imiquimod, agonista del recettore toll-like, a basso peso molecolare.
Sono stati trattati. con 5% imiquimod crema, 123 tumori cutanei di vario tipo, tra cui carcinoma a cellule basali (BCC), carcinoma a cellule squamose (SCC), malattia di Bowen, eritroplasia di Queyrat, morbo di Paget, e Tricoepiteliomi. I tumori erano situati soprattutto sul viso, schiena, tronco e gambe.
Per i pazienti senza comorbidità, il tasso complessivo di guarigione è stata del 73%. Per questi pazienti, i tassi di guarigione sono stati 85,7% per BCC superficiali e nodulari, 88% per BCC superficiali, 57% per la malattia di Bowen, 50% per BCC nodulare, e 50% per BCC inizialmente aggressivo. Un SCC ha mostrato risposta completa, e tumori causati da malattia di Paget e eritroplasia di Queyrat hanno presentato risposta parziale.
Nessuno dei tumori considerati clinicamente guarito ricorreva. Trentasette lesioni non hanno dimostrato alcuna risposta alla imiquimod. Sono stati considerati fattori di rischio: presenza di comorbilità cutanee, tumori ad alto rischio, come BCC misti aggressivi (sclerodermiforme o micronodulare), BCC nodulare, o malattia di Bowen, e assenza di reazione locale di imiquimod-
I pazienti con risposta all’ imiquimod, anche quando non avevano dimostrato reazione locale, potevano subire un altro ciclo di trattamento con imiquimod con risposta completa.
Il modello di guarigione comprendeva buoni risultati cosmetici.
In questa esperienza imiquimod risulta come un’opzione di trattamento efficace per diversi tipi di tumori cutanei, specialmente nei pazienti senza comorbidità cutanea e con tumori a basso rischio. Particolrmente per i pazienti con controindicazioni ad intervento chirurgico. Gli effetti collaterali sono tollerabili.
Treatment of cutaneous tumors with topical 5% imiquimod cream.
Alessi SS et al.
.Clinics (Sao Paulo)2009;64(10):961-6.
There are various approaches to the treatment of cutaneous tumors; one of them is treatment with imiquimod, a synthetic toll-like receptor agonist with a low molecular weight that offers a topical, noninvasive, and non-surgical therapeutic option. The main objective of our study was to provide data on 89 patients who used a 5% imiquimod cream for the treatment of cutaneous tumors at the Cutaneous Oncology Group of the Dermatology Department of Hospital das Clinicas from 2003 to 2008.
MATERIALS AND METHODS: Here, we present our experience in the treatment of 123 cutaneous tumors of various types, including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), Bowen’s disease, erythroplasia of Queyrat, Paget’s disease, and trichoepithelioma, with 5% imiquimod cream from 2003 to 2008 in the Cutaneous Oncology Group of the Dermatology Department of Hospital das Clinicas. Patients were divided into two separate groups according to their diagnosis and comorbidities; these comorbidities included epidermodysplasia verruciformis, xeroderma pigmentosum, albinism, basal cell nevus syndrome, Brooke-Spiegler syndrome, HIV, chronic lymphocytic leukemia, B-cell lymphoma, and kidney transplantation. Treatment duration, response to imiquimod, follow-up, recurrence, and local and systemic reactions associated with use of the drug were analyzed. Epidemiological data were obtained and cure rates were calculated.
RESULTS: The ratio of women to men was 1.28:1, and the mean age was 63.1 years. Tumors were located mainly on the face, back, trunk, and legs. For patients with comorbidities, the overall cure rate was 38%. These specific patients demonstrated cure rates of 83.5% for superficial BCC and 50% for Bowen’s disease. Aggressive BCC and superficial and nodular BCC did not present a good response to treatment. Trichoepitheliomas and nodular BCC showed a partial response, and erythroplasia of Queyrat showed a complete response. For patients without comorbidities, the overall cure rate was 73%. For these patients, the cure rates were 85.7% for superficial and nodular BCC, 88% for superficial BCC, 57% for Bowen’s disease, 50% for nodular BCC, and 50% for aggressive BCC. One SCC lesion demonstrated a complete response, and tumors caused by Paget’s disease and erythroplasia of Queyrat presented a partial response. None of the tumors considered as clinically cured recurred. Thirty-seven lesions demonstrated no response to imiquimod. Having a cutaneous comorbidity, high-risk tumors such as mixed aggressive BCC (sclerodermiform or micronodular), nodular BCC, or Bowen’s disease, and presenting no local reaction to imiquimod were considered as risk factors for a worse prognosis. We demonstrate that patients with no response to imiquimod, even when they demonstrated no local reaction, can undergo another cycle of six weeks of imiquimod treatment and show a complete response. The healing pattern led to good cosmetic outcomes, and the side effects were tolerable.
CONCLUSIONS: Our experience confirms imiquimod as an effective treatment option for several types of cutaneous tumors, especially in patients without the cutaneous comorbidities cited above and with low-risk tumors. Imiquimod has a relatively low cost compared to other therapeutic options and can be delivered via ambulatory care to patients with surgery contraindications, and its side effects are tolerable.