{"id":247306,"date":"2016-09-15T11:45:33","date_gmt":"2016-09-15T11:45:33","guid":{"rendered":"https:\/\/www.pm360online.com\/sequential-protocol-benefits-patients-with-field-cancerization\/"},"modified":"2016-09-15T11:45:33","modified_gmt":"2016-09-15T11:45:33","slug":"sequential-protocol-benefits-patients-with-field-cancerization","status":"publish","type":"post","link":"https:\/\/www.pm360online.com\/sequential-protocol-benefits-patients-with-field-cancerization\/","title":{"rendered":"Sequential protocol benefits patients with field cancerization"},"content":{"rendered":"
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EXPERT ANALYSIS FROM AAD SUMMER ACADEMY 2016<\/p>\n

BOSTON (FRONTLINE MEDICAL NEWS)<\/span> <\/span> \u2013 Field cancerization poses unique treatment challenges, but useful approaches to managing patients with such extreme dermatoheliosis are emerging, according to Anokhi Jambusaria-Pahlajani, MD.<\/p>\n

In patients with extensive sun damage to the head and neck, she said she performs initial curettage of any hyperkeratotic actinic keratoses, followed by topical 0.5% 5-fluorouracil applied twice daily on postcurettage days 1 through 5. On day 6, she performs aminolevulinic acid photodynamic therapy (PDT) with 1 hour of incubation.<\/p>\n

\u201cBasically, on day zero they come into my office, and I look for anything that\u2019s hyperkeratotic, and I numb it up and curette it. The goal of that is to get rid of the scale so that when I do the topical 5-fluorouracil or I do the photodynamic therapy, the medicine is actually getting to where we want it to go,\u201d Dr. Jambusaria-Pahlajani<\/a>,<\/span> a dermatologist in Round Rock, Tex., said at the American Academy of Dermatology summer meeting.<\/p>\n

She discussed one such patient \u2013 a lung transplant recipient \u2013 in whom this approach worked particularly well. At 6 months\u2019 follow-up, the patient had had a significant response, and during a follow-up of at least 2 years, he did not develop a single actinic keratosis.<\/p>\n

Early results with this combination approach were so encouraging that she and her colleagues published a case series of four solid organ transplant recipients. \u201cAll four patients tolerated the approach well, demonstrated excellent response to treatment with complete or near complete resolution of actinic keratosis and squamous cell carcinoma in situ lesions,\u201d she said. At 1-6 months following treatment, \u201cbasically patients were clear,\u201d she added ( Dermatol Surg. 2016 Jan;42:S66-72<\/a> <\/span> ).<\/p>\n

Dr. Jambusaria-Pahlajani also said she has seen \u201cgreat results\u201d in most of the 30-40 other patients she has treated using this approach. \u201cI\u2019ve followed up patients for years, and they really haven\u2019t had a problem like what they had prior to getting this treatment,\u201d she said.<\/p>\n

She noted that, anecdotally, many patients who had been treated with multiple courses of topical 5-fluorouracil monotherapy or photodynamic therapy actually preferred the combination approach. They felt that they were out of commission for a shorter period of time, and most of the patients \u201ctended to be kind of red and inflamed for about 7-10 days total from start to finish, which was a lot better than with, for example, 5-fluorouracil,\u201d she said.<\/p>\n

One patient \u2013 another lung transplant recipient \u2013 initially responded to combination therapy, but returned in 3 months with numerous recurrent lesions. Based on findings from a 2010 study, a cyclic approach to PDT was tried in this patient. In that study of 12 solid organ transplant recipients, cyclic PDT reduced the incidence of squamous cell carcinoma ( Dermatol Surg. 2010 May;36[5]:652-8<\/a> <\/span> ).<\/p>\n

The study subjects had a high burden of squamous cell carcinoma in situ. The cyclic PDT they received included blue light PDT with 1 hour of incubation every 4-8 weeks for 2 years. The median number of new invasive and in situ squamous cell carcinomas declined from about 20 to 4 in the first year (a 79% reduction vs. 1 month prior to first treatment) and to 1 at 2 years (a 95% reduction).<\/p>\n

\u201cThis patient happened to be a transplant patient as well, but I think you could also use [this approach] in nontransplant patients,\u201d Dr. Jambusaria-Pahlajani said. His response was \u201cpretty significant,\u201d and after 18 months of treatment he was doing well.<\/p>\n

\u201cThe main thing that you have to remember, though, is that these patients have to be willing to come in every 4-8 weeks to get the PDT,\u201d which, she added, \u201cis not for every patient.\u201d It\u2019s also not for every provider. Aside from staff or resource access limitations, these treatments can be very time consuming and costly, she noted. \u201cTreating these patients can be a challenge, but it can be rewarding, as well,\u201d she commented.<\/p>\n

She reported having no relevant financial disclosures.<\/p>\n

sworcester@frontlinemedcom.com<\/a> <\/span> <\/p>\n<\/p><\/div>\n","protected":false},"excerpt":{"rendered":"

EXPERT ANALYSIS FROM AAD SUMMER ACADEMY 2016 BOSTON (FRONTLINE MEDICAL NEWS) \u2013 Field cancerization poses unique treatment challenges, but useful …<\/p>\n","protected":false},"author":59236,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[68702,56417,56420,56416],"tags":[],"_links":{"self":[{"href":"https:\/\/www.pm360online.com\/wp-json\/wp\/v2\/posts\/247306"}],"collection":[{"href":"https:\/\/www.pm360online.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.pm360online.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.pm360online.com\/wp-json\/wp\/v2\/users\/59236"}],"replies":[{"embeddable":true,"href":"https:\/\/www.pm360online.com\/wp-json\/wp\/v2\/comments?post=247306"}],"version-history":[{"count":0,"href":"https:\/\/www.pm360online.com\/wp-json\/wp\/v2\/posts\/247306\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.pm360online.com\/wp-json\/wp\/v2\/media?parent=247306"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.pm360online.com\/wp-json\/wp\/v2\/categories?post=247306"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.pm360online.com\/wp-json\/wp\/v2\/tags?post=247306"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}