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Imiquimod 5% and 5-fluorouracil creams both efficacious, but recurrences more common with 5-fluorour

Topical creams imiquimod 5% and 5-fluorouracil both appear to be efficacious for low-risk superficial basal cell carcinoma (BCC), but recurrences were more common with 5-fluorouracil group compared to the imiquimod 5% arm, according to a three-year post treatment follow-up study.

The goal of the study, reported on Apr. 23, 2016 online in the Journal of Investigative Dermatology, was to establish the long-term safety and efficacy of imiquimod 5% and 5-fluorouracil creams in the treatment of superficial BCC.

A total of 601 patients were enrolled in this single blind, non-inferiority, randomized controlled multicentre trial with a one-year (Lancet Oncol June 2013; 14(7):647–654) and three-year post treatment follow-up, according to researchers from the Netherlands.

The investigators evenly allocated three noninvasive therapies; 16% methyl aminolevulinate photodynamic therapy (MAL-PDT) was the third treatment tested.

Results of the study indicate superior long-term results among patients receiving imiquimod topical treatments with an 80% tumor-free clearance rate after three years. The 5-fluorouracil and MAL-PDT were less effective, with a 68% and 58% clearance rate, respectively.

Fluorouracil less expensive, but had more recurrences

“Based on our findings, both [imiquimod 5% and 5-fluorouracil creams] are effective noninvasive treatments in most primary, low-risk superficial BCC, but the data provide no definite evidence for superiority of imiquimod to fluorouracil,” said Dr. Marieke H. Roozeboom, senior author of the Journal of Investigative Dermatology article, who was quoted in a press release.

The use of topical creams for the treatment of superficial BCC have the added benefit that they can be administered by the patient.

“Both creams have an equal cosmetic outcome and risk of local adverse events. Fluorouracil has the added advantage of being less expensive than imiquimod. However, between one- and three-year follow-up, more recurrences were diagnosed in the fluorouracil group compared with the imiquimod group,” added Dr. Roozeboom, of the Department of Dermatology, Maastricht University Medical Center in the Netherlands.

The treatment preferences of patients can be complex, and influenced by multiple factors.

“When choosing a treatment for an individual patient with a superficial BCC, other factors like age, compliance, and patient preferences should always be taken into account. For example, we have found that in superficial BCC on the lower extremities in older patients, PDT should be prescribed rather than imiquimod,” explained Dr. Roozeboom.

“Throughout the last two decades there has been a growing interest in these non-surgical therapies, which offer the possibility of avoiding surgery and reducing demands of busy medical practices,” said Dr. Roozeboom.

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