Imiquimod - Its role in the treatment of cutaneous malignancies

Abstract

Imiquimod is a synthetic imidazoquinolone amine, which has potent immune response modifier activity, when topically used. This characteristic property of imiquimod has led to its use in a number of applications in dermatology, particularly in cutaneous malignancies, where it has been found to be effective and safe. Currently, additional mechanisms for its activity in actinic keratosis, basal cell carcinoma, and invasive squamous cell carcinoma have been elucidated. Its usage for cutaneous metastasis in breast cancer has been a further addition to its therapeutic armamentarium recently.

Actinic keratosis – review for clinical practice

“…The release of cytokines and chemokines causes an influx of inflammatory cells into the lesions and consequently its destruction mediated by innate response immune cells, such as natural killer (NK) cells, and adaptive response cells, such as cytotoxic T lymphocytes. Therefore, the development of an inflammatory reaction predicts a good therapeutic efficacy …”

“…The characteristic properties of IQ have led to its use in several dermatological applications, including genital warts, AK, and superficial basal cell carcinoma. IQ has also been used in the treatment of cutaneous metastasis of breast cancer …”

“…The 5% formulation is indicated for topical use in immunocompetent adults with two applications for 16 weeks on an area up to 25 cm 2 . The 3.75% formulation has an advantage over the 5% one since it presents similar efficacy but with less degree of adverse events and a shorter time of use with the possibility of application on a larger area . This formulation has yet a 35.6% probability of complete cure and recurrence rate after 12 months of 20.9% .…”

Toll‐like receptors: The role in bladder cancer development, progression and immunotherapy

“…Imiquimod is for the topical treatment of superficial basal cell carcinoma with beneficial effects due to activation of innate and adaptive antitumour immune responses and could be considered as a potent adjuvant with cancer vaccines . Imiquimod, also named Aldara or R‐837, considered as a TLR7 agonist and induces proinflammatory immune response with the same mechanism of action as BCG act.…”

“…135 TLR 7 agonists are small molecules and induce immunity through MYD88dependent pathway and caspase-dependent mitochondrial pathway, leading to stimulation of a series of antitumour activities. 133 Imiquimod is for the topical treatment of superficial basal cell carcinoma with beneficial effects due to activation of innate and adaptive antitumour immune responses 136 and could be considered as a potent adjuvant with cancer vaccines. 137 Imiquimod, also named Aldara or R-837, considered as a TLR7 agonist and induces proinflammatory immune response with the same mechanism of action as BCG act.…”