Gorlin Group Talk Nov 2012

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"B.C.C. Management and Treatment Options. Dr J T Lear"

Text of Gorlin Group Talk Nov 2012

  • 1. BCC Management and Treatment Options Dr JT Lear, Dermatology CentreManchester Royal Infirmary & Dermatology Centre Hope Hospital, Manchester
  • 2. BASAL CELL CARCINOMAManagement and Treatment Options November 2012 Dr John Lear Consultant Dermatologist, Central Manchester Hospitals 2
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  • 8. Results in nBCC:Lesion response & cosmesis (PP) 3- month follow-up MAL-PDT Surgery MAL-PDT Surgery100 98 100 9190 90 8280 8070 7060 6050 5040 40 3330 3020 2010 10 0 0 Complete response Cosmetic outcomes Rhodes et al; Arch Dermatol 2004; 140:1723
  • 9. nBCC: 5 year recurrence rates MAL-PDT vs. surgery100 98 91 90 80 70 60 50 MAL-PDT 40 Excision 30 20 14 14 14 10 10 4 0 0 2 4 4 0 3mth 12mth 24mth 36mth 48mth 60mth CRR RR RR RR RR RR
  • 10. nBCC: 5 year recurrence rates MAL-PDT MAL-PDT has now shown long term recurrence rates: - higher (14%) than surgery (4%) at least equivalent to recurrence rates of standard alternative treatments to surgery PDT offers the benefit of non invasiveness, rapid healing and better cosmetic outcome than surgery
  • 11. Long term outcomes MAL-PDT:superficial basal cell carcinoma (sBCC)
  • 12. sBCC: 5 year recurrence rates MAL-PDT vs cryotherapy 97 95100 90 80 70 60 50 MAL-PDT 40 22 19 22 Cryotherapy 30 17 19 19 22 20 20 9 13 10 0 3mth 12mth 24mth 36mth 48mth 60mth CRR RR RR RR RR RR
  • 13. sBCC: 5 year recurrence rates MAL-PDT No new recurrences after 36 months Long term recurrence rates similar to recurrence rates of standard cryotherapy (22% vs 20%) PDT offers non invasive, rapid healing and better cosmetic outcome than cryotherapy Should be considered as a standard therapy for sBCC
  • 14. Long term outcomes MAL-PDT: Difficult- to-treat basal cell carcinoma BCC
  • 15. Why PDT for difficult-to-treat BCC? Surgery, may be inappropriate in a number of situations Large or many lesions, poor ability to heal, poor vasculature, co-morbidities such as immunosuppression, diabetes, anticoagulant medication risk of keloid scarring
  • 16. Study design Open studies in difficult-to-treat sBCC and nBCC 94 patients, 123 lesions in European study 102 patients, 187 lesions in Australian study 2 MAL-PDT treatment sessions (160 mg/g, 3 hr); cycle repeated in the absence of CR Assessed clinical and histological response, recurrence, cosmetic outcome, safety
  • 17. Definition of difficult-to-treat Definition of difficult-to-treat large BCC: largest diameter >15 mm on extremities; >20 mm on trunk; >15 mm on face BCC lesion located in H-zone as described by Swanson (mid-face, temple or ear) patient at high risk of surgical complications bleeding abnormalities, anticoagulant medication and/or cardiac recurrent lesions Lesions in severely sun-damaged skin
  • 18. Long term recurrence rates 100 92 90 87 80 70 60% 50 Europe 40 29 Australia 30 28 24 20 1815 18 20 10 8 8 0 3m 12m 24m 36m 48m 60m CRR RR RR RR RR RR Horn et al; Br J Dermatol 2003; 149(6):12421249; Vincuillo et al; Poster, World Congress of Cancers of the Skin, 2003
  • 19. Imiquimod - Phase III Studies 724 patients enrolled Imiquimod 5% cream administered either 5x/week or 7x/week for 6 weeks vs vehicle Biopsy confirmed sBCC meeting study size requirements (between 0.5 and 2.0 cm) Tumour site clinically evaluated 12 weeks post-treatment, excised and evaluated histologicallyGeisse et al. 2004
  • 20. Comparison of Clin / Histo, and Histological Clearance 100 Clinical 90 & histological 82 clearance (ITT) 79 80 75 73 HistologicalResponse rate (%) 70 clearance (ITT) 60 p