Adjuvante topische Interferon-α-2b-Therapie bei epithelialen Tumoren der Augenoberfläche

Liposomes: Structure, Biomedical Applications, and Stability Parameters With Emphasis on Cholesterol

Liposomes are essentially a subtype of nanoparticles comprising a hydrophobic tail and a hydrophilic head constituting a phospholipid membrane. The spherical or multilayered spherical structures of liposomes are highly rich in lipid contents with numerous criteria for their classification, including structural features, structural parameters, and size, synthesis methods, preparation, and drug loading. Despite various liposomal applications, such as drug, vaccine/gene delivery, biosensors fabrication, diagnosis, and food products applications, their use encounters many limitations due to physico-chemical instability as their stability is vigorously affected by the constituting ingredients wherein cholesterol performs a vital role in the stability of the liposomal membrane. It has well established that cholesterol exerts its impact by controlling fluidity, permeability, membrane strength, elasticity and stiffness, transition temperature (Tm), drug retention, phospholipid packing, and plasma stability. Although the undetermined optimum amount of cholesterol for preparing a stable and controlled release vehicle has been the downside, but researchers are still focused on cholesterol as a promising material for the stability of liposomes necessitating explanation for the stability promotion of liposomes. Herein, the prior art pertaining to the liposomal appliances, especially for drug delivery in cancer therapy, and their stability emphasizing the roles of cholesterol.

Epidemiological characteristics and clinical course of eyelid squamous cell carcinoma patients from a large tertiary centre between 2009 and 2020

BACKGROUND/AIMS

To assess epidemiological tumour features, risk factors, clinical management and outcome of eyelid squamous cell carcinoma (SCC) and changes thereof. Furthermore, we searched for validating predictors of the American Joint Committee on Cancer (AJCC) 8 classification system.

METHODS

We evaluated data of 117 patients with histologically proven eyelid SCC at a large tertiary German university centre between January 2009 and March 2020. This retrospective, monocentric analysis included descriptive statistics and non-parametric tests (p<0.05).

RESULTS

Histologically controlled excision and follow-up was performed in 88 (75.2%) patients. In the remaining patients with higher T-category, individual adjuvant therapy combinations were initiated. We found higher numbers of nodal metastasis and recurrence for male patients and higher T-category (p=0.035, p=0.008 and p=0.001, p<0.001). Recurrence rates proved higher for patients with multiple lesions (p=0.008). Disease-specific survival (DSS) was 95.7% at 2 and 94.9% at 5 years of follow-up. Six patients (5.1%) died from eyelid SCC with nodal metastasis and higher T-category being negative prognostic factors (p<0.001 and p=0.009). Mortality was associated with tumour location in the medial upper eyelid, nodal metastasis being more frequent (p=0.001 and p=0.009) and tumour of the lower eyelid alone as positive predictor (p=0.012). T category differed in 34 (29.1%) patients when comparing AJCC 7 and 8 (p<0.001). Changes in T category as per the AJCC 8 classification resulted in better prediction of DSS (p=0.024).

CONCLUSION

Special attention should be paid to male patients, tumour location in the upper medial eyelid and lymph node diagnostics. Prediction of DSS proved superior as per the AJCC 8 staging system.

Evaluation of a short-term topical interferon α-2b treatment for histologically proven melanoma and primary acquired melanosis with atypia

OBJECTIVE

To evaluate the efficiency of series of 6-week treatments with brief intervals (6-week = 1 cycle) of topical Interferon α-2b (IFNα-2b) treatment in primary acquired melanosis (PAM) with atypia and melanoma of the conjunctiva.

PATIENTS AND METHODS

Five patients with biopsy-proven PAM with atypia and seven patients with melanoma of the conjunctiva, treated with topical IFNα-2b (1 million units/ml, 5 times daily), were included in the study. All patients had colour photographs and the tumour area was measured manually for each patient before and after treatment.

RESULTS

The median age of 12 patients at initiation of treatment was 61.5 years (range 39-75 years). The mean therapy duration was 2.4 cycles (range 1-6 cycle). Compared to pretreatment lesion dimension, the mean decrease in tumour size were after the first cycle 66% (range 18-98%; p = 0.004; n = 10 patients), after the second cycle 55% (range 10-100%; p = 0.016; n = 7 patients), and after the third cycle 74% (range 23-100%; n = 3 patients). In one patient 6 cycles of topical IFNα-2b were needed. The decrease in size was 22% after the 4(th) cycle, 34% after the 5(th) cycle, and 98% after the 6(th) cycle.

CONCLUSION

Our clinical experience demonstrates promising results of topical IFNα-2b treatment for PAM with atypia and melanoma of the conjunctiva without any local or systemic side effects. However, future multicenter prospective studies are recommended to confirm the efficiency and safety of topical IFNα-2b treatment.

[Invasive squamous cell carcinoma of the conjunctiva]

We report the case of a 71-year-old male who was first diagnosed with conjunctival squamous cell carcinoma in September 2010. The lesion was excised twice and cryotherapy of the margins was performed. On histology the margins were not tumor-free but this was not followed up by further excision. After 5 months the patient was referred to this department with a growing tumor mass which had infiltrated into the anterior chamber and partly destroyed the iris. Because of this advanced finding extended enucleation was performed. The histological examination showed a well differentiated squamous cell carcinoma and no evidence of metastasis in lymph nodes or elsewhere could be found by conventional computed tomography (CT) and positron emission CT (PET-CT).

Clinical findings and management of conjunctival intraepithelial neoplasia

BACKGROUND

Conjunctival intraepithelial neoplasia (CIN) is the most common tumor of the ocular surface and is a precursor to invasive squamous cell carcinoma. CIN comprises a spectrum of premalignant epithelial neoplasia that usually begins near the limbus and spreads to the cornea.

METHODS

This case report reviews the clinical findings and management of CIN, with a discussion of the histopathology and etiology of this tumor.

CONCLUSION

CIN has a variety of clinical presentations, including gelatinous, leukoplakic, or papilliform. Because of their malignant potential, these lesions must be differentiated carefully and treated promptly. Traditional management of CIN is surgical excision with cryotherapy, but other topical treatments are being explored with promising results.

[Isolated corneal intraepithelial dysplasia]

We present the case of an 83-year-old patient with an isolated epithelial dysplasia of the cornea. After corneal abrasion the lesion reoccurred 14 days later. The abrasion was then increased to cover the whole corneal epithelium and adjacent limbal and conjunctival areas were also biopsied. Histology revealed a corneal epithelial dysplasia stage 3, whereas the limbal and conjunctival biopsies showed normal epithelium. After resection two cycles of local mitomycin C application (2 cycles of 14 days each) were administered and 9 months after the second intervention the cornea remained clear with good vision. The investigation for human papillomavirus showed a type 6, which is not associated with an increased risk of malignancy.

Differenzialdiagnose und Therapieoptionen bei Tumoren der Konjunktiva

The diagnostic classification of most conjunctival tumors is based on case history, inspection, and examination with the slit lamp microscope. Further imaging procedures are rarely indicated when malignant processes are not circumscribed. Clinical classification then also includes palpation and echographic examination of regional lymph nodes. Pigmented and nonpigmented melanocytic nevi are the most frequent conjunctival tumors. An important practical biomicroscopic cardinal symptom of the most frequent nevi is the presence of epithelial pseudocysts. Essential in practice is the histopathological confirmation of the clinical diagnosis, e.g., distinguishing between nonpigmented melanomas and sebaceous gland carcinomas with a pagetoid growth pattern or squamous cell carcinomas. Depending on the course and findings, the following therapeutic measures can be indicated: cryotherapy, chemotherapy, radiotherapy, modified enucleation, orbital exenteration, or a combination of different methods.

Tumor-Volume Increase at Beginning of Primary Treatment with Topical Interferon Alpha 2-β in a Case of Conjunctiva-Cornea Intraepithelial Neoplasia

AIMS

The aim of this study was to report on the effectiveness and tumor side effects of topical interferon (INF) alpha 2-beta in a case of conjunctiva-cornea intraepithelial neoplasia (CIN) of a patient that rejected any surgical procedure.

METHODS

This study is a case report description.

RESULTS

An 81-year-old man with a history of neoplasies of the colon and prostate and anticoagulant treatment was referred for treatment of an ocular surface neoplasia on his left eye. Pathognomonic signs of CIN were present. The patient rejected surgical procedures. A regimen of topical INF alpha 2-beta 4 times daily was administered. An increase in tumor volume of 25% was observable 15 days after the beginning of therapy. No subjective discomfort was reported. The treatment continued with follow-ups every 15 days. The progressive regression was remarkable. Complete regression of the CIN was observable after 60 days of therapy. No other side-effects were detected.

CONCLUSIONS

Topical INF alpha 2-beta is a valid choice for the treatment of CIN in patients for whom surgery is not possible. The increase of tumor volume at the beginning of therapy does not require the suspension of treatment.

Interferon therapy for ocular disease

PURPOSE OF REVIEW

Interferons were first known for their antiviral action. Immunomodulatory therapy with interferons has been studied in various diseases. This paper summarizes the role and presumed mechanisms of action of type 1 interferons in the treatment of ocular disease.

RECENT FINDINGS

Preliminary data show beneficial effects of interferons in ocular disease such as Behçet disease and multiple sclerosis-associated uveitis in terms of visual acuity, intraocular inflammation activity, and chronic macular edema. Another mode of application is topical as an adjuvant treatment in viral keratitis or ocular surface malignancies.

SUMMARY

Interferons are gaining a place in the treatment of ocular disease. Evidence is growing of their potential in ocular Behçet disease and multiple sclerosis-associated uveitis. Randomized, controlled clinical trials are needed to confirm this observation. Further insights into the complex mechanisms of action of interferons in health and disease will increase understanding of their mechanisms of action as a therapeutic substance.