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What is the success rate of topical imiquimod 5% cream (US brand: Aldara) to treat infiltrative basal cell carcinoma (BCC)?

So far I've only found some case study {1} and some study on using topical imiquimod 5% cream in complement to surgical excisions {2}.


References:

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    Whoever rated this -1: Why?
    – Thomas
    Oct 31 '20 at 21:39
0

From the 2007 study {1}, imiquimod 5% cream successfully treated infiltrative BCCs for 60% of the 26 studied patients (outcome at 5-year follow-up)

For the intent-to-treat data set, the long-term clearance rate for imiquimod was 65% for all BCCs (n = 36), 100% for superficial BCCs (n = 4), 75% for nodular BCCs (n = 6), 60% for infiltrative BCCs (n = 26), and 65% for both dosing regimens (n = 23 and n = 13). Multivariate analysis demonstrated that only baseline BCC size had a significant association with long-term clearance (P = .02) (odds ratio, 0.99; 95% confidence interval, 0.98-0.10): the smaller the tumor, the higher the chance to be cured with imiquimod.

Limitations:

  1. Small sample size.
  2. Two authors of the study have disclosed a conflict of interest (paid by 3M Pharmaceuticals, which manufactures Imiquimod).
  3. The study was published in 2007. Hopefully larger, more objective studies have been published since then.

In the 2018 study {2}, in table 1, 4 out of 5 infiltrative BCC were has retreated with imiquimod 5% cream (5 days/week during 6 weeks). Outcome at around 5-year follow-up.

The 2013 letter {3} strongly advises against using imiquimod for a BCC that has not been confirmed to be superficial via biopsy:

In any way there should be a clear consensus today that imiquimod treatment should only be applied to superficial BCC which have been biopsied before. Treatment of nodular or more aggressive BCC with imiquimod is obsolete. In case of recurrence after imiquimod treatment, surgery is always more damaging and more expensive because of the increased aggressivity as well as the poor clinical delimitation of these tumors.

A similar concern is shared by the 2015 letter {4} for fluorouracil (but likely the same argument can be made for imiquimod):

However, despite approval since the 1970’s, the Veterans Affairs Topical Tretinoin Chemoprevention trial noted that prior treatment with topical fluorouracil was associated with a higher risk of development of morpheaform BCCs. These authors concede that fluorouracil may have destroyed superficial cancer cells while leaving deeper pockets untouched. However, they open the door to a causal relationship between therapy and these tumors by stating that “fluorouracil treatment may predispose to development of morpheaform BCC.”


References:

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