Nonsurgical Treatments for Skin Cancer: Retinoids and α‐Interferon

Abstract

Retinoids, the natural and synthetic analogs of vitamin A, and alpha-interferon have been used effectively in the treatment of certain cutaneous premalignancies and malignancies. Retinoids have shown impressive activity against premalignant disorders of the skin (actinic keratoses, keratoacanthoma, epidermodysplasia verruciformis) and of other epithelial sites (oral leukoplakia, cervical dysplasia). In established basal cell skin cancers, topical retinoid treatment has produced a complete response rate of 33%, and systemic retinoids have produced an objective response rate of 51%. In advanced squamous cell skin cancers, systemic retinoids have produced a response rate of over 70%. Intralesional alpha-interferon has produced impressive responses and systemic alpha-interferon has produced a 50% objective response rate in basal and squamous cell carcinoma. Retinoid therapy and alpha-interferon have produced modest overall results in melanoma, although striking individual responses have been reported. In cutaneous T-cell lymphoma, which is notably refractory to chemotherapy, retinoids and alpha-interferon have produced responses in 60%+ and 70%+ of cases, respectively. Retinoids and alpha-interferon, either alone or in combination, offer exciting prospects for primary and neoadjuvant therapy for advanced malignancy. Retinoids also show promise as relatively nontoxic preventive and adjuvant therapy. Researchers should focus on integrating these drugs with other biological response modifiers, differentiation agents, and cytotoxic drugs for treating advanced malignancy.

Phase II and Biologic Study of Interferon Alfa, Retinoic Acid, and Cisplatin in Advanced Squamous Skin Cancer

“…[3][4][5][6][7][8][9][10][11][12][13][14][17][18][19][20][21][22] Certain important comparisons can be made between the present trial and our previous phase II trial demonstrating the activity of only 13cRA and IFN␣ in advanced skin SCC. The major activity occurred in locally advanced disease: overall response and CR rates of 67% (eight of 12) and 33% (four of 12), respectively.…”

“…34 These studies provide insights into the mechanisms of the RA and IFN components of the present study's regimen. 3,4 Cisplatin (75 to 100 mg/m 2 every 3 to 4 weeks) for skin SCC has been involved in only two previous series with greater than 10 patients. 3,4 Cisplatin (75 to 100 mg/m 2 every 3 to 4 weeks) for skin SCC has been involved in only two previous series with greater than 10 patients.…”

Use of Recombinant Interferon Alfa-2b in the Treatment of Basal Cell Carcinoma

“…In 1988, Grob et al [12] reported the same results in 8 patients treated with IFN alfa-2a. Lippman et al [ 16] utilized intralesional IFN in 7 patients with BCC; in 6 of these patients, a complete response was achieved. More recently, Cornell et al 117] treated 172 patients with ulcerative and superficial BCC with IFN alfa-2b.…”

Treatment of Cutaneous T‐cell Lymphomas (CTCL) with Extracorporeal Photochemotherapy

“…All ofthese treatments are generally effective against CTCL, but cannot cure all patients, especially those with late-stage or aggressive disease. Therefore, several new effective modalities have been applied to CTCL, including biological response modifiers (BRMs), such as interleukin-2 (IL-2) and interferons (IFNs) (4,5), combination BRM therapy using IL-2 and IFN, IL-2 and tumor necrosis factor (TNF) or BRMs, and chemotherapeutics for patients with advanced malignancy (6). These latter combination therapies, BRMs and chemotherapeutics, are reported to be more effective than BRM therapy alone (6).…”