Author Interviews, Cancer Research, Dermatology, Surgical Research / 15.12.2016
Surgery Versus 5% Imiquimod for Nodular and Superficial Basal Cell Carcinoma
MedicalResearch.com Interview with:
Hywel C. Williams DSc, FMedSci, NIHR Senior Investigator
Director of the NIHR Health Technology Assessment Programme
http://www.nets.nihr.ac.uk/programmes/hta
Professor of Dermato-Epidemiology and Co-Director of the Centre of Evidence-Based Dermatology,
http://www.nottingham.ac.uk/research/groups/cebd/index.aspx
University of Nottingham,
Queen’s Medical Centre,
Nottingham University Hospitals NHS Trust,
Nottingham UK
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Our clinical trial of 5% imiquimod cream versus surgery for low risk basal carcinoma (BCC) of the skin was first prompted by a shocking lack of randomised controlled clinical trials for what is the commonest form of human cancer.
We had conducted a Cochrane systematic review prior to starting the study and found very few long term studies. An emerging literature on imiquimod cream at the time suggested that it might have a clinically useful effect for low risk BCC. All the studies were short term and industry supported, so with the support of Cancer Research UK (UK largest cancer charity), we undertook a large independent study to see how the cream compared to the reference standard of excision surgery with a 4mm margin for low risk superficial and nodular BCC.
Our three year results, published in Lancet Oncology, showed that surgery is clearly superior to imiquimod cream, with a success rate (absence of initial failure and no signs of recurrence at 3 years) of 98.4% compared to 83.6% for imiquimod. Nevertheless, the 83.6% success rate is still potentially useful, so we wanted to see whether these 3 year results were sustained. So we followed up your study participants for a total of 5 years and found that the response rates at 5 years were almost the same as those at 3 years (97.7% and 82.5% for surgery and imiquimod respectively).
Most treatment failures with imiquimod occurred early on ie in the first year of treatment. Our study shows that if initial treatment works, the benefits are sustained.
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