A Non-Surgical and Cost-Effective Treatment Approach Employing Topical Imiquimod, 5-Fluorouracil, and Tretinoin for Primary Non-Melanoma Skin Cancers
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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.
Insights
The combination of imiquimod, 5-fluorouracil, and tretinoin with cryotherapy demonstrated high clearance rates for non-melanoma skin cancers. This triple-drug regimen proved most effective compared to other tested combinations.
Area of Science:
- Dermatology
- Oncology
- Pharmacology
Background:
- Minimally invasive treatments for non-melanoma skin cancers are limited.
- Established treatment options often have drawbacks or are unproven.
Purpose of the Study:
- To evaluate the efficacy of different topical anti-tumor agent combinations with cryotherapy for non-melanoma skin cancers.
- To compare the clearance rates of imiquimod/tretinoin, 5-fluorouracil/tretinoin, and imiquimod/5-fluorouracil/tretinoin regimens.
Main Methods:
- Retrospective study of 186 non-melanoma skin cancer cases in 133 patients over ten years.
- Patients received one of three topical drug combinations with cryotherapy every two weeks.
- Clearance was defined as no recurrence for at least three years post-treatment, assessed via multivariable logistic regression.
Main Results:
- The combination of imiquimod/5-fluorouracil/tretinoin showed the highest lesion clearance rates.
- Imiquimod/tretinoin and 5-fluorouracil/tretinoin combinations were associated with significantly lower clearance likelihoods.
- Morpheaform basal cell carcinoma exhibited a lower probability of clearance.
Conclusions:
- The combination of imiquimod, 5-fluorouracil, and tretinoin alongside cryotherapy is a highly effective treatment for non-melanoma skin cancers.
- This triple-drug regimen represents the most effective treatment approach identified in the study.
- Further research may explore optimizing this combination for various skin cancer subtypes.
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