RHODES, GREECEPhotodynamic therapy using topical methyl aminolevulinate has efficacy comparable to cryotherapy for the treatment of basal cell carcinoma and actinic keratoses but provides substantially better cosmetic outcomes, according to data presented at the 15th Congress of the European Academy of Dermatology and Venereology.
In a multicenter study of 120 patients with superficial basal cell carcinoma who were randomized to photodynamic therapy with methyl aminolevulinate (MAL-PDT) or cryotherapy, complete responses were seen in 97% of those in the MAL-PDT group and 95% of those in the cryotherapy group at 3 months, Dr. Nicole Basset-Seguin reported in a poster.
The recurrence rate at 60 months also was similar in the two groups: 22% in the MAL-PDT group and 20% for cryotherapy patients, reported Dr. Basset-Seguin of Hôpital Saint Louis, Paris.
The investigators, however, rated cosmetic outcomes as excellent far more frequently in the MAL-PDT group (56%) than in the cryotherapy group (14%) at the 60-month follow-up.
In this study, MAL-PDT was provided as a single treatment. Patients who failed to respond at 3 months were retreated with an additional two consecutive MAL-PDT sessions 7 days apart. Cryotherapy was applied in two freeze-thaw cycles using liquid nitrogen spray. Patients who failed to respond were retreated with double freeze-thaw cryotherapy.
In another study presented at the meeting, MAL-PDT was superior to cryotherapy for treatment of actinic keratoses.
A total of 119 subjects with 1,501 cumulative lesions were treated on one side of the face or scalp with MAL-PDT and on the other side with double freeze-thaw cryotherapy. The treatments were randomly allocated to the sides of the face/scalp and were repeated at 12 weeks in those with incomplete response, Dr. Colin Morton of the Falkirk (Scotland) Royal Infirmary, reported in a poster.
At 12 weeks, significantly more patients in the MAL-PDT group had a reduction from baseline in the number of lesions, compared with cryotherapy (84% vs. 75%, respectively), and at 24 weeks, both groups showed similar reductions in the number of lesions from baseline (89% and 88%).
Both treatments were safe and well tolerated, and subject and investigator ratings of cosmetic outcome "clearly favored MAL-PDT," Dr. Morton wrote.
Both studies were sponsored by Galderma, maker of the PDT devices used.