Frequency and Cost of Actinic Keratosis Treatment

Warino, Lindsey; Tusa, Mark G.; Camacho, Fabian; Teuschler, Hoa; Fleischer, Alan B.; Feldman, Steven R.

doi:10.1097/00042728-200608000-00010

Cited by 26 publications

(40 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Baseline actinic keratoses counts in this study were less than 9 on the treated sites (35). Given the exceptionally high baseline numbers of actinic keratoses in our trial (median baseline counts in the calcipotriol plus 5-FU group: 16 Table 1), together with the inclusion of hypertrophic actinic keratoses, calcipotriol plus 5-FU treatment for 4 days appears to be more effective than the currently approved topical field treatments for actinic keratoses. Nonetheless, future head-to-head clinical trials are required to fully address the efficacy of calcipotriol plus 5-FU combination compared with current treatment regimens.…”

Section: Tslp Hla Class II and Cellular Stress Signal Synergism In mentioning

confidence: 58%

“…Considering that actinic keratoses constitute the third most common reason for consulting a dermatologist (12) and incur an annual cost of over $900 million in the United States (16), the development of an effective treatment to eliminate actinic keratoses and prevent progression to skin cancer with fewer applications and side effects would have a major impact on healthcare.…”

Section: Impact Of Transient Tslp Induction By Calcipotriol On Skin Cmentioning

confidence: 99%

See 1 more Smart Citation

Randomized trial of calcipotriol combined with 5-fluorouracil for skin cancer precursor immunotherapy

Cunningham

Tabacchi

Eliane

et al. 2016

Journal of Clinical Investigation

135

113

View full text Add to dashboard Cite

Premalignant lesions of cutaneous squamous cell carcinoma (SCC) are identified clinically as actinic keratoses (12,13). Several field-directed treatments including 5-fluorouracil (5-FU), diclofenac, ingenol, and imiquimod have been approved for the treatment of sun-damaged skin with multiple actinic keratoses (13-15). However, the long treatment duration and the severity BACKGROUND. Actinic keratosis is a precursor to cutaneous squamous cell carcinoma. Long treatment durations and severe side effects have limited the efficacy of current actinic keratosis treatments. Thymic stromal lymphopoietin (TSLP) is an epithelium-derived cytokine that induces a robust antitumor immunity in barrier-defective skin. Here, we investigated the efficacy of calcipotriol, a topical TSLP inducer, in combination with 5-fluorouracil (5-FU) as an immunotherapy for actinic keratosis. METHODS.The mechanism of calcipotriol action against skin carcinogenesis was examined in genetically engineered mouse models. The efficacy and safety of 0.005% calcipotriol ointment combined with 5% 5-FU cream were compared with Vaseline plus 5-FU for the field treatment of actinic keratosis in a randomized, double-blind clinical trial involving 131 participants. The assigned treatment was self-applied to the entirety of the qualified anatomical sites (face, scalp, and upper extremities) twice daily for 4 consecutive days. The percentage of reduction in the number of actinic keratoses (primary outcome), local skin reactions, and immune activation parameters were assessed. RESULTS.Calcipotriol suppressed skin cancer development in mice in a TSLP-dependent manner. Four-day application of calcipotriol plus 5-FU versus Vaseline plus 5-FU led to an 87.8% versus 26.3% mean reduction in the number of actinic keratoses in participants (P < 0.0001). Importantly, calcipotriol plus 5-FU treatment induced TSLP, HLA class II, and natural killer cell group 2D (NKG2D) ligand expression in the lesional keratinocytes associated with a marked CD4 + T cell infiltration, which peaked on days 10-11 after treatment, without pain, crusting, or ulceration.CONCLUSION. Our findings demonstrate the synergistic effects of calcipotriol and 5-FU treatment in optimally activating a CD4 + T cell-mediated immunity against actinic keratoses and, potentially, cancers of the skin and other organs.TRIAL REGISTRATION. ClinicalTrials.gov NCT02019355. FUNDING. Not applicable (investigator-initiated clinical trial).

show abstract

Section: Tslp Hla Class II and Cellular Stress Signal Synergism In mentioning

confidence: 58%

Section: Impact Of Transient Tslp Induction By Calcipotriol On Skin Cmentioning

confidence: 99%

Randomized trial of calcipotriol combined with 5-fluorouracil for skin cancer precursor immunotherapy

Cunningham

Tabacchi

Eliane

et al. 2016

Journal of Clinical Investigation

135

113

View full text Add to dashboard Cite

show abstract

“…Furthermore, 5% of 22 clinically diagnosed actinic keratosis were identified histologically as BCC [17] and 12% of 514 presumed BCC's were diagnosed histologically as actinic keratosis. [18] Studies have also shown that the majority of SCC's that arise from actinic keratoses arise in the same area or in close proximity to the actinic keratosis.…”

Section: Resultsmentioning

confidence: 99%

“…Other studies have also indicated that 60% of SCC's occurred at a site where an actinic keratosis had been recorded previously. [18] An American study concluded that 10% of actinic keratosis progressed to SCC due to chronic sun exposure especially UVB sunlight. A retrospective study concluded that the length of time for an actinic keratosis to progress to an SCC was determined to be 24.6 months (95% Confidence interval, 21.04-28.16 months).…”

Section: Resultsmentioning

confidence: 99%

Actinic Keratosis and Squamous Cell Carcinoma

Lalji¹

2014

CRDOA

View full text Add to dashboard Cite

“…Darüber hinaus findet in einem sehr geringen Teil der Fälle eine maligne Transformation zum Platten epithelkarzinom statt [6]. In den betroffenen Bevöl-kerungsgruppen sind AK auch wirtschaftlich von Bedeutung, da die jähr lichen Behandlungskosten sehr hoch sind [7,8].…”

Section: Introductionunclassified

Epidemiologie der aktinischen Keratose

Green¹

2015

Kompass Dermatol

View full text Add to dashboard Cite

Die Epidemiologie der aktinischen Keratose (AK) spiegelt deren Verursachung durch kumulative Sonnenexposition wider: Am höchsten ist die Prävalenz bei hellhäutigen Menschen, die in niedrigen Breitengraden leben; besonders betroffen sind die Körperregionen, die der Sonne am meisten ausgesetzt sind, nämlich Hände, Unterarme und Gesicht. AK-Läsionen deuten auf ein erhöhtes Risiko für Basalzellkarzinom, Plattenepithelkarzinom und Melanom hin, vor allem wenn sie in großer Zahl vorliegen und sich zu Arealen sogenannter Feldkanzerisierung vereinigen. Die wichtigsten Risikofaktoren sind männliches Geschlecht, höheres Alter, sonnenempfindlicher Teint, hohe kumulative Sonnenexposition und längerfristige Immunsuppression. Die klinische Auszählung der AK ermöglicht die Beurteilung und Beobachtung der AK-Krankheitslast, jedoch ist eine wirklich präzise Zählung kaum möglich, besonders bei stark lichtgeschädigter Haut. Mehrfach ist nachgewiesen worden, dass AK-Auszählungen unzuverlässig sind, auch wenn sie durch spezialisierte Dermatologen vorgenommen werden. Ungeachtet dieser Herausforderungen zeigt die qualitative Betrachtung von AK-Verläufen eine hohe Umsatzrate, bei der neue Läsionen entstehen und sich vorhandene Läsionen zurückbilden. Ein sehr geringer Anteil der AK-Läsionen durchläuft eine maligne Transformation, jedoch ist die genaue Rate aufgrund der Mängel in der langfristigen AK-Beobachtung unbekannt. Die Primärprävention von AK besteht in der Meidung intensiver Sonneneinstrahlung durch Schutzmaßnahmen wie dem Aufenthalt im tiefen Schatten, schützender Kleidung und regelmäßigem Auftragen von Sonnenschutzmittel auf exponierte Hautareale von frühester Jugend an.

show abstract

Frequency and Cost of Actinic Keratosis Treatment

Cited by 26 publications

References 5 publications

Randomized trial of calcipotriol combined with 5-fluorouracil for skin cancer precursor immunotherapy

Randomized trial of calcipotriol combined with 5-fluorouracil for skin cancer precursor immunotherapy

Actinic Keratosis and Squamous Cell Carcinoma

Epidemiologie der aktinischen Keratose

Contact Info

Product

Resources

About