Topical immunomodulation under systemic immunosuppression: results of a multicentre, randomized, placebo-controlled safety and efficacy study of imiquimod 5% cream for the treatment of actinic keratoses in kidney, heart, and liver transplant patients

Ulrich, Claas; Bichel, Jens; Euvrard, Sylvie; Guidi, Beatrice; Proby, Charlotte M.; Kerkhof, P.C.M. van de; Amerio, Paolo; Rønnevig, Jørgen; Slade, Herbert B.; Stockfleth, Eggert

doi:10.1111/j.1365-2133.2007.08269.x

Cited by 145 publications

(95 citation statements)

References 19 publications

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“…99 Despite theoretical concerns that imiquimod, an immunomodulator, might be inappropriate for or ineffective in immunosuppressed patients, there is no evidence that it promotes graft rejection, and a full 16-week course of imiquimod 3 times weekly significantly reduced the number of AKs in OTR patients. 29,95 Over 8 months of observation, the number of SCCs was also significantly lower with imiquimod, relative to a vehicle control. 95 PDT is an attractive option for AK and NMSC prophylaxis in OTRs because of the ability to treat wide areas.…”

Section: Aks In Organ Transplant Recipientsmentioning

confidence: 99%

“…29,95 Over 8 months of observation, the number of SCCs was also significantly lower with imiquimod, relative to a vehicle control. 95 PDT is an attractive option for AK and NMSC prophylaxis in OTRs because of the ability to treat wide areas. AK clearance with ALA-PDT appears equally effective in immunosuppressed and immunocompetent people.…”

Section: Aks In Organ Transplant Recipientsmentioning

confidence: 99%

“…94,95 AKs in OTRs may be morphologically different from typical AKs, appearing more prominent (wartlike) and hyperkeratotic, and their SCCs are at elevated risk of local recurrence and metastasis. 94 While systemic acitretin is commonly prescribed to OTRs to restrict the development of AKs, this retinoid acts by promoting epidermal turnover.…”

Section: Aks In Organ Transplant Recipientsmentioning

confidence: 99%

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Non-melanoma Skin Cancer in Canada Chapter 3: Management of Actinic Keratoses

et al. 2015

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Background Actinic keratosis (AK) and cheilitis (AC) are lesions that develop on photodamaged skin and may progress to form invasive squamous cell carcinomas (SCCs). Objective To provide guidance to Canadian health care practitioners regarding management of AKs and ACs. Methods Literature searches and development of graded recommendations were carried out as discussed in the accompanying introduction (chapter 1 of the NMSC guidelines). Results Treatment of AKs allows for secondary prevention of skin cancer in sun-damaged skin. Because it is impossible to predict whether a given AK will regress, persist, or progress, AKs should ideally be treated. This chapter discusses options for the management of AKs and ACs. Conclusions Treatment options include surgical removal, topical treatment, and photodynamic therapy. Combined modalities may be used in case of inadequate response. AKs are particularly common following the longterm immunosuppression in organ transplant patients, who should be monitored frequently to identify emerging lesions that require surgery.

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Section: Aks In Organ Transplant Recipientsmentioning

confidence: 99%

Section: Aks In Organ Transplant Recipientsmentioning

confidence: 99%

Section: Aks In Organ Transplant Recipientsmentioning

confidence: 99%

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Non-melanoma Skin Cancer in Canada Chapter 3: Management of Actinic Keratoses

et al. 2015

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“…In der his tologisch kontrollierten, verblindeten eu ropäischen Multicenterstudie konnte eine komplette Abheilung aller AK im Studie nareal bei 62,1% der Patienten der Verum gruppe beobachtet werden. In der Place bogruppe lag die Abheilungsrate hingegen bei 0%, und es konnte besonders bei den höher immunsupprimierten Herz und Nierentransplantierten eine weitere star ke Zunahme der AK dokumentiert wer den [36]. Die parallel erhobenen immun und transplantatspezifischen Parameter waren auch unter der ImiquimodThera pie unauffällig und stabil.…”

Section: Imiquimodunclassified

“…Die im mer wieder berichteten Fälle eines kom pletten Nichtansprechens auf Immunmo dulatoren scheinen sowohl bei Organ transplantierten als auch bei immunkom petenten Patientenkollektiven aufzutre ten. Da Imiquimod eine nur leicht abge schwächte Effizienz in der Herztransplan tiertengruppe der europäischen Multicen terstudie zeigte, scheint eine alleinige Er klärung über die Wechselwirkung mit der systemischen Immunsuppression daher unwahrscheinlich [3,36].…”

Section: Imiquimodunclassified

Primär- und Sekundärprophylaxe von Hauttumoren nach Organtransplantation

et al. 2010

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Skin cancer constitutes the most frequently reported post-transplant malignancy in solid organ transplant recipients (OTR) worldwide. Whereas the risk for malignant melanoma is only moderately increased, non-melanoma skin cancers (NMSC) seem to thrive on chronic immunosuppression and account for up to 95% of post-transplant cutaneous malignancies. Compared to the general population cutaneous squamous cell carcinoma (SCC) and actinic keratoses (AK) characteristically show even higher incidences than basal cell carcinoma (BCC) and act as an indicator for the development of multiple primary cutaneous neoplasias and locally recurrent cancers (field cancerization). Early diagnosis and therapy of pre-malignant cutaneous lesions is crucial for the secondary prophylaxis of further invasive and highly aggressive skin cancers. High quality interdisciplinary care and prophylactic modalities, including consistent and sufficient UV protection, topical immunmodulatory therapies of UV-damaged skin areas, retinoid chemoprevention as well as tapering immunosuppressive treatment or the selection of immunosuppressants with proposed antiangiogenic properties like mTor-inhibitors may help to reduce the multiplicity of subsequent primary skin cancers in high-risk patients. Apart from the continuous need for educational intervention of OTR in the primary prophylaxis of post-transplant skin cancers, dermatologic care occupies a central position within the field of transplantation medicine in terms of pre- and post-transplantation dermatologic evaluation and therapy as well as the implication of timely and effective secondary preventive approaches in the management of this high-risk patient population.

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Consensus-Based Recommendations on the Prevention of Squamous Cell Carcinoma in Solid Organ Transplant Recipients

Massey

Schmults

et al. 2021

JAMA Dermatol

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IMPORTANCEThere is a paucity of evidence to guide physicians regarding prevention strategies for cutaneous squamous cell carcinoma (CSCC) in solid organ transplant recipients (SOTRs).OBJECTIVE To examine the development and results of a Delphi process initiated to identify consensus-based medical management recommendations for prevention of CSCC in SOTRs.EVIDENCE REVIEW Dermatologists with more than 5 years' experience treating SOTRs were invited to participate. A novel actinic damage and skin cancer index (AD-SCI), consisting of 6 ordinal stages corresponding to an increasing burden of actinic damage and CSCC, was used to guide survey design. Three sequential web-based surveys were administered from January 1, 2019, to December 31, 2020. Pursuant to Delphi principles, respondents thoroughly reviewed all peer responses between rounds. Supplemental questions were also asked to better understand panelists' rationale for their responses.FINDINGS The Delphi panel comprised 48 dermatologists. Respondents represented 13 countries, with 27 (56%) from the US. Twenty-nine respondents (60%) were Mohs surgeons. Consensus was reached with 80% or higher concordance among respondents when presented with a statement, question, or management strategy pertaining to prevention of CSCC in SOTRs. A near-consensus category of 70% to less than 80% concordance was also defined. The AD-SCI stage-based recommendations were established if consensus or near-consensus was achieved. The panel was able to make recommendations for 5 of 6 AD-SCI stages. Key recommendations include the following: cryotherapy for scattered actinic keratosis (AK); field therapy for AK when grouped in 1 anatomical area, unless AKs are thick in which case field therapy and cryotherapy were recommended; combination lesion directed and field therapy with fluorouracil for field cancerized skin; and initiation of acitretin therapy and discussion of immunosuppression reduction or modification for patients who develop multiple skin cancers at a high rate (10 CSCCs per year) or develop high-risk CSCC (defined by a tumor with approximately Ն20% risk of nodal metastasis). No consensus recommendation was achieved for SOTRs with a first low risk CSCC.CONCLUSIONS AND RELEVANCE Physicians may consider implementation of panel recommendations for prevention of CSCC in SOTRs while awaiting high-level-of-evidence data. Additional clinical trials are needed in areas where consensus was not reached.

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Topical immunomodulation under systemic immunosuppression: results of a multicentre, randomized, placebo-controlled safety and efficacy study of imiquimod 5% cream for the treatment of actinic keratoses in kidney, heart, and liver transplant patients

Abstract: Imiquimod appears to be a safe alternative for the treatment of multiple actinic keratoses in patients with solid organ transplants. Efficacy was within the range previously observed in nontransplanted populations.

Cited by 145 publications

References 19 publications

Non-melanoma Skin Cancer in Canada Chapter 3: Management of Actinic Keratoses

Non-melanoma Skin Cancer in Canada Chapter 3: Management of Actinic Keratoses

Primär- und Sekundärprophylaxe von Hauttumoren nach Organtransplantation

Consensus-Based Recommendations on the Prevention of Squamous Cell Carcinoma in Solid Organ Transplant Recipients

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