Abstract
BackgroundAggressive non-melanoma skin cancer (deeply infiltrating, recurrent, and morphea form lesions) are therapeutically challenging because they require considerable tissue loss and may demand radical disfiguring surgery. Interferons (IFN) may provide a non-surgical approach to the management of these tumors. The aim of this work was to evaluate the effect of a formulation containing IFNs-α and -γ in synergistic proportions on patients with recurrent, advanced basal cell (BCC) or squamous cell skin carcinomas (SCSC).MethodsPatients with extensive, recurrent, resistant to other procedures BCC or SCSC received the IFN formulation peri- and intralesionally, three times per week for 3 weeks. They had been previously treated with surgery and/or radiotherapy or chemotherapy. Thirteen weeks after the end of treatment, the original lesion sites were examined for histological evidence of remaining tumor.ResultsSixteen elder (median 70 years-old) patients were included. They beared 12 BCC and 4 SCSC ranging from 1.5 to 12.5 cm in the longest dimension. At the end of treatment 47% CR (complete tumor elimination), 40% PR (>30% tumor reduction), and 13% stable disease were obtained. None of the patients relapsed during the treatment period. The median duration of the response was 38 months. Only one patient with complete response had relapsed until today. Principal adverse reactions were influenza-like symptoms well known to occur with interferon therapy, which were well tolerated.ConclusionThe peri- and intralesional combination of IFNs-α and -γ was safe and showed effect for the treatment of advanced, recurrent and resistant to previous treatments of BCC and SCSC in elder patients. This is the first report of such treatment in patients with advance non-melanoma skin cancer. The encouraging result justifies further confirmatory trials.Trial registrationCurrent Controlled Trials RPCEC00000052.
Highlights
Aggressive non-melanoma skin cancer are therapeutically challenging because they require considerable tissue loss and may demand radical disfiguring surgery
The role played by the immune system in immunocompetent patients with skin cancer is less clear, but ultraviolet (UV) radiation exposure is recognized as a critical factor in basal cell carcinoma (BCC) pathogenesis, presumably partly because of resulting immune suppression [5]
BCC has bee associated with increase vascularity likely because of increased expression of CXCR-4, a receptor for stromal cell-derived factor 1 alpha (SDF-1) [6]
Summary
Aggressive non-melanoma skin cancer (deeply infiltrating, recurrent, and morphea form lesions) are therapeutically challenging because they require considerable tissue loss and may demand radical disfiguring surgery. Non-melanoma skin cancers (NMSC) have a high incidence over the world, including basal cell carcinoma (BCC) and squamous cell skin carcinomas (SCSC), the most common neoplasms of the human being worldwide [1], irrespective of ethnicity [2]. The incidence of these tumors has risen [3], probably due to increase of aging population, improved detection, an increased use of tanning beds, and environmental factors such as increased sun exposure and ozone layer depletion which are known to increase the risk of BCC [4]. BCCs have been shown to evade T cell response by secreting IL-10, by shedding ICAM-1 or by down-regulation of IFN-γ receptors (and HLA-class II antigens) [9] and by killing infiltrating citotoxic T cells [10]
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