Imiquimod 5% cream in the treatment of Bowen's disease - 02/09/11
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 cm2 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. (J Am Acad Dermatol 2001;44:462-70.)
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 | This study was funded and initiated by 3M Pharmaceuticals (St Paul, Minn) and carried out at the Skin and Cancer Foundation, Darlinghurst, Australia. The authors at the Skin and Cancer Foundation have no stock, equity ownership, or patent licensing arrangements with 3M Pharmaceuticals and have not received payments for conducting or publicizing the study. All payments were made directly to the Skin and Cancer Foundation, which is a nonprofit research and education center for dermatology.The authors receive salaries from the Skin and Cancer Foundation, and this was not varied as a result of carrying out this study. |
| Reprint requests: Associate Professor Steven Kossard, FACD, Skin and Cancer Foundation Australia, 277 Bourke St, Darlinghurst NSW 2010, Australia. |
Vol 44 - N° 3
P. 462-470 - mars 2001 Retour au numéro
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