采用局部咪喹莫特、5-氟尿嘧啶和维 A 酸治疗原发性非黑素瘤皮肤癌的非手术、具有成本效益的治疗方法。

A Non-Surgical and Cost-Effective Treatment Approach Employing Topical Imiquimod, 5-Fluorouracil, and Tretinoin for Primary Non-Melanoma Skin Cancers.

出版信息

J Drugs Dermatol. 2021 Mar 1;20(3):260-267. doi: 10.36849/JDD.5427.

DOI:10.36849/JDD.5427

PMID:33683072

Abstract

BACKGROUND

Minimally invasive alternative approaches to treat non-melanoma skin cancers remain limited and unproven.

OBJECTIVE

We aim to assess the efficacy of varying combinations of anti-tumor agents—imiquimod 5% cream, 5-fluorouracil 2% solution, and tretinoin 0.1% cream—with brief cryotherapy in treating non-melanoma skin cancers.

METHODS

This retrospective study included 690 cases of non-melanoma skin cancers in 480 patients who received a diagnosis of a basal cell carcinoma or squamous cell carcinoma during a ten-year period. During treatment period, patients applied 30 applications of one of three combinations (imiquimod/tretinoin, 5-fluorouracil/tretinoin, or imiquimod/5-fluorouracil/tretinoin) and had cryotherapy every 2 weeks. Each patient had a clinical examination at least three years post-treatment or documented treatment failure. Clearance was defined by a lack of persistence or recurrence for 3 years following the completion of treatment. The likelihood of lesion clearance was evaluated using multivariable logistic regression analysis.

RESULTS

A total of 186 cases (97; basal cell carcinoma and 89; squamous cell carcinoma) in 133 patients [37% women and 63% men; median (interquartile range) age, 77 (69, 83) years] met the inclusion criteria. Multivariable logistic regression analysis adjusting for clinical and lesion variables demonstrated that, relative to the imiquimod/5-fluorouracil/tretinoin treatment approach, imiquimod/ tretinoin (odds ratio, 0.05; 95% confidence interval, 0.00-0.99) and 5-fluorouracil/tretinoin (0.02; 0.00–0.45) were associated with lower likelihoods of lesion clearance. Likewise, morpheaform basal cell carcinoma had a lower probability of clearance (0.05; 0.00–0.72).

CONCLUSIONS

The combination of imiquimod/5-fluorouracil/tretinoin with cryotherapy had high clearance rates and was the most effective treatment regimen. J Drugs Dermatol. 2021;20(3):260-267. doi:10.36849/JDD.5427.

摘要

背景

治疗非黑素瘤皮肤癌的微创替代方法仍然有限且未经证实。

目的

我们旨在评估不同组合的抗肿瘤药物——咪喹莫特 5%乳膏、5-氟尿嘧啶 2%溶液和维 A 酸 0.1%乳膏——与短暂冷冻疗法联合治疗非黑素瘤皮肤癌的疗效。

方法

这项回顾性研究纳入了 480 名患者的 690 例非黑素瘤皮肤癌病例，这些患者在十年期间被诊断为基底细胞癌或鳞状细胞癌。在治疗期间，患者应用三种组合之一（咪喹莫特/维 A 酸、5-氟尿嘧啶/维 A 酸或咪喹莫特/5-氟尿嘧啶/维 A 酸）的 30 次应用，并每 2 周进行一次冷冻疗法。每位患者在治疗后至少 3 年进行临床检查或记录治疗失败。清除定义为治疗完成后 3 年内无持续或复发。使用多变量逻辑回归分析评估病变清除的可能性。

结果

共有 133 名患者中的 186 例（97 例基底细胞癌和 89 例鳞状细胞癌）[37%为女性，63%为男性；中位（四分位距）年龄，77（69，83）岁]符合纳入标准。多变量逻辑回归分析调整了临床和病变变量，结果表明，与咪喹莫特/5-氟尿嘧啶/维 A 酸治疗方法相比，咪喹莫特/维 A 酸（比值比，0.05；95%置信区间，0.00-0.99）和 5-氟尿嘧啶/维 A 酸（0.02；0.00-0.45）与较低的病变清除可能性相关。同样，苔藓样基底细胞癌的清除可能性较低（0.05；0.00-0.72）。