Photodynamic therapy with a 5‐ALA patch does not increase the risk of conversion of actinic keratoses into squamous cell carcinoma

Photodynamic Therapy Review: Principles, Photosensitizers, Applications, and Future Directions

Photodynamic therapy (PDT) is a minimally invasive therapeutic modality that has gained great attention in the past years as a new therapy for cancer treatment. PDT uses photosensitizers that, after being excited by light at a specific wavelength, react with the molecular oxygen to create reactive oxygen species in the target tissue, resulting in cell death. Compared to conventional therapeutic modalities, PDT presents greater selectivity against tumor cells, due to the use of photosensitizers that are preferably localized in tumor lesions, and the precise light irradiation of these lesions. This paper presents a review of the principles, mechanisms, photosensitizers, and current applications of PDT. Moreover, the future path on the research of new photosensitizers with enhanced tumor selectivity, featuring the improvement of PDT effectiveness, has also been addressed. Finally, new applications of PDT have been covered.

5-Aminolaevulinic acid patch photodynamic therapy for the treatment of actinic keratoses: preliminary results from an Italian study in the real-life setting

BACKGROUND

Photodynamic therapy (PDT) is recommended for both lesion and field therapy of actinic keratoses (AKs). The 5-aminolaevulinic acid (5-ALA) patch PDT is indicated for the treatment of isolated mild AKs (≤1.8 cm) on the face and bald scalp. It was demonstrated to be effective and safe in clinical trials with a good tolerability profile.

METHODS

In this retrospective multicenter real-life study, 33 patients with a total of 99 AKs of the scalp, face, ears, and/or hands and 2 actinic cheilitis were treated with one treatment session of 5-ALA patch PDT with a red light source (total dose of 37 J/cm2).

RESULTS

Overall, 12 weeks after treatment, 68/99 (69%) lesions were completely cleared. Complete response was obtained in 82% of AKs on the ears, 78% on the face, 57% on the hands, and 56% on the scalp and in the two actinic cheilitis. The treatment was very effective on grade I AKs, cleared in 87% of the cases and less efficient on grade II-III lesions, cleared in 47% of the cases. 5-ALA patch PDT was well tolerated with a good to excellent cosmetic outcome in 97% of the patients and with 94% of the patients being satisfied or very satisfied with the treatment.

CONCLUSIONS

Our results confirm that 5-ALA patch PDT is a good option for AK treatment in clinical practice, it is easy to use, effective and well tolerated even in difficult-to-treat-areas. Moreover, it has an excellent cosmetic outcome.

Efficacy of aminolevulinic acid 20 % solution photodynamic therapy in the treatment of actinic keratoses on the upper extremities: A post hoc analysis of a phase 3, randomized, vehicle-controlled trial

BACKGROUND

Photodynamic therapy with 5-aminolevulinic acid is indicated for targeted treatment of actinic keratoses on the face, scalp, and upper extremities. This was a post hoc analysis of a phase 3 randomized trial assessing the efficacy of aminolevulinic acid/photodynamic therapy for treatment of actinic keratoses on the upper extremities.

METHODS

Adults with 4-15 grade 1-2 actinic keratosis lesions on ≥1 upper extremity were randomized (1:1) to receive aminolevulinic acid/photodynamic therapy or vehicle/photodynamic therapy applied to individual lesions followed by occlusion and blue light treatment. Assessments included the clearance rate of treated lesions vs baseline, cumulative disease area clearance, and complete clearance by lesion size.

RESULTS

There were 135 and 134 patients randomized to aminolevulinic acid/photodynamic therapy and vehicle/photodynamic therapy groups, respectively. At 12 weeks, clearance of treated lesions (80.6 % vs 45.5 %; P <0.0001) and the mean decrease in cumulative disease area (82.4 % vs 42.6 %; P <0.0001) was significantly higher for aminolevulinic acid/photodynamic therapy vs vehicle/photodynamic therapy, respectively. Rates of complete clearance and clearance by cutpoint (≥90 %, ≥85 %, ≥80 %, or ≥75 % clearance) were numerically higher for aminolevulinic acid/photodynamic therapy. Clearance of lesions was higher for aminolevulinic acid/photodynamic therapy vs vehicle/photodynamic therapy regardless of baseline lesion size. Aminolevulinic acid/photodynamic therapy was well tolerated with adverse events consistent with those expected with photodynamic therapy.

CONCLUSIONS

Aminolevulinic acid photodynamic therapy is effective and well tolerated for the treatment of actinic keratosis lesions of the extremities.

A Systematic Review and Meta-Analysis of Interventions for Actinic Keratosis from Post-Marketing Surveillance Trials

Multiple interventions are available for the treatment of actinic keratosis (AK) showing high efficacy in pivotal trials. However, data from post-marketing surveillance studies have received little attention until now. Here, we systematically investigate interventions for AK from post-marketing surveillance trials as a proxy for real-world efficacy and tolerability. A systematic literature search was conducted in Medline, Embase, and CENTRAL. Pertinent trial registers were hand-searched until 25 March 2020. Results were pooled using a random-effects model to calculate pooled proportions and relative risks (RR) or were described qualitatively. Eleven records with a total sample size of n = 4109 were included. Three of the studies had an active-controlled design, while seven were single-armed. Participant complete clearance ranged from 23.1% for diclofenac sodium 3% gel to 88.9% for ingenol mebutate 0.05% gel. The lesion-specific clearance rate for photodynamic therapy (PDT) was 74% (95% confidence interval (CI) 56–87%). The recurrence rate was significantly higher for diclofenac sodium 3% in comparison to imiquimod 5% cream (RR 1.10, 95% CI 1.02–1.1.8) and ranged from 10.6% for ingenol mebutate 0.015% gel to 23.5% for PDT. Few patients discontinued the trials due to adverse events. The results from the majority of the post-marketing surveillance studies deviated from those of pivotal trials.

Successful Treatment of Adult-Onset Recurrent Respiratory Papillomatosis with CO2 Laser and Photodynamic Therapy

Recurrent respiratory papillomatosis is a noninvasive benign epithelial tumor caused by human papillomavirus. Clinically, it featured rapid growth, multifocus, and frequent recurrence. Though a number of therapies have been investigated, the recurrence after treatment is always a challenge. In this report, we describe a 27-year-old male patient with recurrent respiratory papillomatosis who was treated with CO₂ laser therapy followed by 5-aminolevulinic acid photodynamic therapy (ALA-PDT). There was no adverse reaction after treatment and no recurrence during the follow-up time.