Topical Antineoplastic Agents in the Treatment of Mucocutaneous Diseases

Abstract

Topical antineoplastic agents have a well-established role in the treatment of several dermatological conditions. Their use in the treatment of mucosal skin disease also has gained increasing recognition. Topical 5-fluorouracil (5-FU), an antimetabolite, and imiquimod, an immunomodulatory agent with antitumor properties, are the two principal topical antineoplastic agents used in the treatment of mucocutaneous diseases. Although the vast majority of their mucosal uses are currently not approved by the Federal Drug Administration, there are numerous case series, open-label studies and randomized controlled trials supporting their uses in the treatment of mucocutaneous diseases. Both topical 5-FU and imiquimod have been successfully utilized in the treatment of a wide range of mucosal diseases, including actinic cheilitis, Bowen's disease of the anal and vulvar mucosa, and genital and perianal condyloma. Reports of their uses in the treatment of mucocutaneous diseases indicate that these agents can be safely administered, though adverse effects such as local inflammation may be augmented when these agents are applied to mucosal surfaces. Additionally, locally acting intralesional chemotherapeutic agents, such as bleomycin and interferon, have well-defined applications in the treatment of mucosal skin diseases such as condyloma acuminata. As further studies are conducted, these topical and intralesional neoplastic agents, in addition to emerging agents that are in various stages of development, such as Toll-like receptor 9 agonists and ingenol mebutate, may play an increasingly important role in the future treatment of mucocutaneous diseases.

Topical therapies for the treatment of anal high-grade squamous intraepithelial lesions

“…Off-label use of imiquimod is common in both skin and mucosal disease 22, 23 with extensive case reports noted in the medical literature. Imiquimod has been reported for treatment of infectious diseases including molluscum contagiosum, genital herpes and cutaneous leishmaniasis 24–26 Finally, imiquimod has been used for treatment of vulvar, penile and anal squamous intraepithelial lesions 27–31 .…”

HIV-Associated Anal Dysplasia and Anal Carcinoma

“…Evaluations of these modalities are rare or currently underway. First cases of successful AIN treatment with Imegenolmebutat or ingenol mebutate have been published [57]. The green tea extract epigallocatechin gallate is licensed for the topical treatment of benign HPV lesions.…”

Actinic keratosis – state of art. Statement of experts of Polish Dermatological Society

“…Nowe badania doświadczalne wskazują, że działanie przeciwnowotworowe imikwimodu utrzymuje się długotrwale po leczeniu. Najczęstszymi działaniami niepożądanymi są nadmierne reakcje zapalne skóry [105,106].…”