Update on pharmacotherapy for ocular surface squamous neoplasia

Abstract

The most frequently encountered non-pigmented tumor of the ocular surface is ocular surface squamous neoplasia (OSSN). Over the past two decades, the pharmacological management of OSSN has grown, with topical 5-fluorouracil, mitomycin, and interferon alpha 2b all being successfully used to treat this disease. Other agents, such as anti-vascular endothelial growth factor (VEGF), retinoic acid, cidofovir and Aloe vera , have less frequently been used in the treatment of OSSN. This review will discuss these pharmacologic agents, summarizing available data and presenting the approach to the treatment of these tumors.

Cost-effective treatment of ocular surface squamous neoplasia for an undocumented and uninsured New York City patient: a case report

“…In addition to using the emergency department as a method of preparing our patient for his OSSN surgery, out-of-pocket out-patient treatments (not covered by his in-patient hospital stay), such as cost of topical chemotherapy and future appointments, present as a challenge to the undocumented and uninsured. Al Bayyat et al noted that out-of-pocket costs for IFNα2b can range between approximately $240 and $600 per month in the USA, while 5-FU and MMC cost $38-$75 and $100-$200 per bottle, respectively [5,7]. Other socioeconomic factors, such as work schedules, payments for office visits, and transportation costs may limit a patient's ability to comply with topical chemotherapy regimens.…”

“…Topical chemotherapy necessitates consistent follow-up from the patient due to its specific scheduled regimens. For example, IFNα2b requires the drops to be used four times a day until clinical resolution, 5-FU is used four times a day for a week followed by a 3-week break, and MMC is used four times a day for a week followed by 2-3 weeks off [5]. Although the number of follow-up appointments for the surgical approach and for the topical chemotherapy approach may be similar, topical chemotherapy was not an option for our patient due to the high out-of-pocket medication costs and previous poor appointment adherence.…”

“…The gold standard for diagnosis of OSSN is histology, while Rose Bengal, lissamine green, and methylene blue stains are non-invasive methods of clinically identifying suspicious OSSN lesions [ 7 – 9 ]. Treatment options include excisional biopsy, cryotherapy, and topical chemotherapy [ 4 , 5 ]. To the best of our knowledge, this is the first documented selection of this cost-effective treatment of OSSN (the use of absolute ethanol along the corneal margin, primary excision, double freeze-thaw cryopexy, and primary conjunctival closure) for an undocumented and uninsured NYC patient.…”

“…The standard of care for OSSN is currently evolving. Numerous studies have tested topical chemotherapy, such as 5-fluorouracil (5-FU), mitomycin C (MMC), and interferon α-2b (IFNα2b), for OSSN [ 5 , 30 ]. Joag et al identified that 82% of cases of OSSN had a complete response to 5-FU as the primary treatment without long-term complications [ 31 ].…”

“…Treatment of OSSN includes a variety of options and even combinations of therapy, such as excisional biopsy, cryotherapy, or topical chemotherapy [4,5]. Personalizing treatment requires evaluation of not just the medical aspects of the condition but also the social needs of the patient.…”