A quantitative systematic review of the efficacy of imiquimod monotherapy for lentigo maligna and an analysis of factors that affect tumor clearance

Mora, Ariana N.; Karia, Pritesh S.; Nguyen, Bichchau Michelle

doi:10.1016/j.jaad.2015.05.022

Cited by 73 publications

(61 citation statements)

References 51 publications

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“…The optimal treatment schedule to achieve clinical and/or histological clearance consisted of a cumulative dose of >60 applications and a treatment intensity of > 5 applications per week. These findings are in line with the results in 347 patients with LM described in the review by Mora et al …”

Section: Discussionsupporting

confidence: 93%

A systematic review on the role of imiquimod in lentigo maligna and lentigo maligna melanoma: need for standardization of treatment schedule and outcome measures

Tio¹,

Woude

Prinsen

et al. 2017

Acad Dermatol Venereol

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Lentigo maligna (LM) is an in situ variant of melanoma. Our objective was to systematically review clinical and histological clearance and recurrence rates of imiquimod treatment of LM with emphasis on progression to lentigo maligna melanoma (LMM). PubMed, EMBASE and the Cochrane library were searched from inception to May 2015. Articles were included if they described histologically proven LM treated with imiquimod 5% monotherapy or combined with another topical therapy. Analysed outcomes were clinical and histological clearance, recurrence rates and number of LMM. The quality was assessed using the GRADE-like checklist, and results were reported according to the PRISMA Statement. Twenty-six case reports, 11 retrospective studies, three prospective studies and one randomized controlled trial were included. One case report of poor quality was excluded. Complete clinical clearance was seen in 369 of 471 patients (78.3%). Histological clearance was present in 285 of 370 (77%) patients. LMM was diagnosed in nine (1.8%) patients 3.9 months (range 0-11 months) post-treatment. Univariate multinominal logistic regression showed that 6-7 applications/week had a 6.47 greater odds (P = 0.017) of resulting in complete clinical clearance compared to 1-4 applications/week. An intensity of 6-7 applications/week showed a 8.85 greater odds (P = 0.003) of resulting in histological clearance compared to 1-4 applications. Applying imiquimod >60 times during a treatment period of 12 weeks (range 4-36) showed a 7.75 greater odds (P = 0.001) of resulting in histological clearance compared to <60 total applications. In conclusion, a treatment schedule using imiquimod 6-7 applications per week, with at least 60 applications, shows the greatest odds of complete clinical and histological clearance of LM. Imiquimod is an option for patients unfit for or not willing to undergo surgery or radiotherapy. Nine cases of LM progressed to LMM shortly after treatment. Our hypothesis is that these LMM may have been present before starting imiquimod.

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Section: Discussionsupporting

confidence: 93%

A systematic review on the role of imiquimod in lentigo maligna and lentigo maligna melanoma: need for standardization of treatment schedule and outcome measures

Tio¹,

Woude

Prinsen

et al. 2017

Acad Dermatol Venereol

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“…These reports revealed the immunostimulatory effect of these agonists through effector cells, such as CD8 + T cells, plasmacytoid DCs or M1 macrophages, and decrease the Tregs and MDSC in the tumor lesion, leading to the inhibition of B16F10 melanoma growth in vivo. In addition, more recently, several crinical trial has proved the antitumor effects of IQM against melanoma in situ (34,35). In our present study, we further elucidated the immunomodulatory effect of IQM on TAMs and splenic CD11b + cells during melanoma growth in vivo, especially focusing on the production of Treg-related chemokines and effector T cells-related chemokines.…”

Section: Discussionmentioning

confidence: 65%

Immunomodulatory Effect of Imiquimod Through CCL22 Produced by Tumor-associated Macrophages in B16F10 Melanomas

Furudate

Fujimura

Kambayashi

et al. 2017

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“…Our pCR rate by detailed pathological examination is lower than the > 75% regression rate judged by clinical inspection and biopsies in a systemic review of predominantly retrospective series and cases. Note that these case reports and series lacked consistent definition and were susceptible to selection and publication bias . Recently, another trial observed a pCR rate of 20 of 38 assessable patients with LM treated with imiquimod for 12 weeks .…”

Section: Discussionmentioning

confidence: 99%

Effect of topical imiquimod as primary treatment for lentigo maligna: the LIMIT-1 study

et al. 2017

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A quantitative systematic review of the efficacy of imiquimod monotherapy for lentigo maligna and an analysis of factors that affect tumor clearance

Cited by 73 publications

References 51 publications

A systematic review on the role of imiquimod in lentigo maligna and lentigo maligna melanoma: need for standardization of treatment schedule and outcome measures

A systematic review on the role of imiquimod in lentigo maligna and lentigo maligna melanoma: need for standardization of treatment schedule and outcome measures

Immunomodulatory Effect of Imiquimod Through CCL22 Produced by Tumor-associated Macrophages in B16F10 Melanomas

Effect of topical imiquimod as primary treatment for lentigo maligna: the LIMIT-1 study

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