Pretreatment with 5-Fluorouracil Cream Enhances the Efficacy of Daylight-mediated Photodynamic Therapy for Actinic Keratosis

Abstract

The efficacy of photodynamic therapy (PDT) with methyl aminolevulinate is reduced when treating actinic keratosis (AK) on the extremities in comparison with the face and scalp. Studies indicate that PDT efficacy can be improved by combining PDT with other treatment modalities. This randomized intra-individual study investigated whether pretreatment with topical 5% 5-fluorouracil (5-FU) enhanced the treatment efficacy of daylight-mediated PDT in 24 patients with AKs on the hands. One hand of each patient was given 7 days of pretreatment with 5-FU twice daily before daylight-PDT, whereas the other hand was treated with daylight-PDT alone. At 3-month follow-up the overall lesion response rate was significantly higher for the combination of 5-FU and daylight-PDT (62.7%) than for daylight-PDT alone (51.8%) (p = 0.001). Furthermore, pain and erythema in relation to treatment were similar in the 2 groups (p = 1.0 and p = 0.2, respectively). Combination therapy is a safe and effective method to improve daylight-PDT for acral AKs.

European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 1: treatment delivery and established indications – actinic keratoses, Bowen's disease and basal cell carcinomas

“…A further randomized placebo‐controlled study of MAL‐PDT using an IPL to treat AK on the dorsal hands achieved complete remission of 55% compared with 3% with light alone . Similar to conventional PDT, 7 days pretreatment with 5‐fluorouracil cream has enhanced DL MAL‐PDT in a study treating AK on dorsum of hands, with superior clearance rates after single PDT session of 62.7% vs. 51.8% compared with PDT alone …”

“…87 Similar to conventional PDT, 7 days pretreatment with 5-fluorouracil cream has enhanced DL MAL-PDT in a study treating AK on dorsum of hands, with superior clearance rates after single PDT session of 62.7% vs. 51.8% compared with PDT alone. 88 PDT for actinic cheilitis A series of 40 patients saw complete clinical response at 3 months in 26 patients with actinic cheilitis following conventional ALA-PDT although with histological evidence of recurrence in nine patients over 18 months of followup. 89 Conventional MAL-PDT clinically cleared 47% of 15 patients although histological clearance was evident in only 4.…”

Efficacy of photodynamic therapy combined with topical interventions for the treatment of actinic keratosis: a meta‐analysis

“…Four of the 10 studies investigated a combination of PDT with imiquimod cream 21,[26][27][28] and three studies a combination of PDT with 5-FU cream. 19,24,25 The remaining three studies assessed a combination of PDT with ingenol mebutate 0.015% gel, 16 tazarotene 0.1% gel 17 and calcipotriol ointment, 30 respectively. Six studies assessed PDT monotherapy 17,19,24,25,27,30 and one study diclofenac monotherapy 21 as comparison.…”

“…19,24,25 The remaining three studies assessed a combination of PDT with ingenol mebutate 0.015% gel, 16 tazarotene 0.1% gel 17 and calcipotriol ointment, 30 respectively. Six studies assessed PDT monotherapy 17,19,24,25,27,30 and one study diclofenac monotherapy 21 as comparison. The remaining three studies had a threearmed design and investigated both PDT and the topical approach as control interventions 16,26,28 (Table 1).…”

Photodynamic therapy in dermatology beyond non-melanoma cancer: An update

“…Complete response rates were significantly higher for AFXL-PDT (73%) compared with AFXL alone (31%) [21]. In addition, topical 5% 5-fluorouracil (5-FU) cream has been reported to enhance the treatment efficacy of PDT in 24 patients with Aks on the hands [22]. Moreover, a new stable nanoemulsion-based gel formulation of 5-ALA for PDT of AKs was reported to be more efficacious when compared with MAL cream [23].…”