Comparison of Topical 5-Fluorouracil and Interferon Alfa-2b as Primary Treatment Modalities for Ocular Surface Squamous Neoplasia

Abstract

Purpose: To compare the efficacy of topical 5-fluorouracil 1% (5FU) and interferon alfa-2b 1 MIU/mL (IFN) eye drops as primary treatment modalities for ocular surface squamous neoplasia (OSSN).Design: Retrospective, comparative, interventional case series.Methods: Fifty-four patients who received 5FU and 48 patients who received IFN as primary therapy for OSSN were included. Primary outcome measures were the frequency of clinical resolution and time to OSSN recurrence by treatment modality. Secondary outcome was the frequency of side effects with each therapy. Results:The mean age of patients was 68 years. More Hispanics were treated with 5FU. In a univariable analysis, frequency of OSSN resolution was higher with 5FU (96.3%, n = 52) than with IFN (81.3%, n = 39), p=0.01. In a multivariable analysis, treatment modality did not remain a significant predictor of resolution. In patients whose OSSN resolved, time to resolution was similar with both agents, (5FU -mean 6.6 months, standard deviation (SD) 4.5 versus IFN -mean 5.5 months, SD 2.9, p = 0.17). Of the 52 eyes whose OSSN resolved with 5FU, 11.5 % of lesions (n=6) recurred while of the 39 eyes whose OSSN resolved with IFN, 5.1% of lesions (n = 2) recurred, p=0.46. Kaplan Meier survival curves of OSSN recurrence were similar between groups (log rank=0.16). One-year recurrence rates were 11.4% with 5FU and 4.5% with IFN. Eyelid edema (p=0.04) and tearing (p=0.02) were more significant with 5FU.

Utility of high-resolution anterior segment optical coherence tomography in the diagnosis and management of sub-clinical ocular surface squamous neoplasia

“…This study found that sub-clinical OSSN was detected by HR-OCT in 17% of patients whose tumors were noted to have resolved clinically. While the clinical implications of sub-clinical disease are unknown, OSSN recurrences are noted in 0-28% of eyes treated with 5-FU and in 4-20% of eyes treated with IFN [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. It can be postulated that recurrences may be driving residual disease or sub-clinical disease, especially since most occurred within the first year after stopping treatment.…”

Update on Diagnosis and Management of Conjunctival Papilloma

“…Used in a recombinant form, administration of topical IFN alpha-2b (IFN α-2b) also leads to anti-proliferative and anti-angiogenic effects. IFN has successfully been administered for the treatment of other HPV-related diseases, such as genital papilloma, cervical intraepithelial neoplasia, and OSSN [86, 87]. Furthermore, it can be beneficial in highly vascularized carcinomas, although these mechanisms of action are not well understood [88].…”

“…Mitomycin C (MMC) is an alkylating agent derived from the actinobacterium Streptomyces caespitosus that exerts its anti-neoplastic effect by cross-linking DNA [104]. It has been used successfully in OSSN [86]. There is a paucity of data in its use for benign squamous papillomas.…”

Management Issues in Conjunctival Tumours: Ocular Surface Squamous Neoplasia

“…intralesional versus topical interferon-a 2b , mitomycin C strength and regimen) that makes comparing these case series fraught with difficulty. Unsurprisingly, reported recurrence rates vary widely, from 0 to 56% with surgical excision alone [9][10][11][12][13], 0-28% with surgical excision followed by topical interferon-a 2b (IFNa 2b ) [12-20], 10-15% with surgical excision followed by topical 5-fluorouracil [16,21,22] and 0-30% with surgical excision followed by topical mitomycin C (MMC) [23][24][25][26][27][28]. From this potpourri of evidence, the clinician must formulate treatment strategies for a diverse patient population, often with many medical comorbidities.…”