10.17.09 ~ 11.10 ~ Marmur ~ PDT Update

10.17.09 ~ 11.10 ~ Marmur ~ PDT Update - Disclosures...

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Photodynamic Therapy for Skin Cancer . . . and beyond Las Vegas October 2009 Ellen Marmur, MD www.ellenmarmur.com Chief, Division of Dermatologic Surgery Mount Sinai Medical Center New York, NY [email protected] Disclosures Medical education faculty for Aquea, Bioform, Allergan (speaker/trainer), Sanofi Aventis Investigator: Dusa, Bioform, Abbott, Genentech Longport Genentech, Longport Scientific advisory board: NuFace Photodynamic therapy for non-melanoma skin cancers: are we there yet? Non-melanoma skin cancers Actinic Keratoses Basal Cell Carcinoma Squamous Cell Carcinoma Evidence Guidelines How I use PDT Chemoprevention Combination Therapy Beyond NMSC Other interesting applications of PDT A perfect PDT patient has a field of AKs Severe actinic damage Photodynamic Therapy (PDT) A chemotherapy for actinic keratoses 2 Stage Process Photosensitizer Photoactivation
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Topical ALA PDT—mechanism ALA is preferentially taken up by rapidly dividing cells non specific for skin cancers ALA is converted to photosensitizer protoporphyrin IX (PpIX) O i i d Oxygen is required: O2 + PpIX + light cytotoxic Singlet Oxygen Singlet Oxygen in mitochondria causes apoptosis and ischemic necrosis King George III: 1788 Marie Stuart, Queen of Scots -- King George III's grandmother six times removed Nebuchadnezzar (c 630-562 BC), was a ruler of Babylon in the Chaldean Dynasty Vincent van Gogh wikipedia.org PpIX absorption in vivo 1.5 2 2.5 b.u.] PDL 585 nm – 595 nm 0 0.5 1 300 350 400 450 500 550 600 650 700 wavelength [nm] absorption [ar BLU-U 417 - 432 nm IPL 560-1200 nm KTP 532 nm ALA and ALA Methyl Ester Two Molecules for ALA PDT of AKs 5-Aminolevulinic Acid (Levulan®, DUSA Pharma) 5-Aminolevulinic Acid Methyl Ester (Metvixia®, Photocure and Galderma) FDA- Approved and Marketed in US as Levulan® Kerastick® FDA- Approved but not yet marketed in US Comparison of Levulan ® and Metvix/Metvixia ® For PDT of Actinic Keratoses Levulan ® Metvix ® /Metvixia ® API Aminolevulinic acid HCl Aminolevulinic acid methyl ester Formulation Alcohol / water solution Peanut oil base ointment Strength 20% 16.8% Approved Indications Actinic Keratosis (US) Actinic Keratosis (US, EU) BCC (EU) AK Lesion Preparation None Curetting Light Activation by Blue light (BLU-U®) Red Light (LED) Efficacy (% Lesion Clearance) 80-90% 80-90% Safety Concerns Photosensitivity 24-48 hours s/p Tx Photosensitivity Dermatitis Incubation Time 14 – 18 hours label 1 hour recent articles 3 hours under occlusion Stability 3 years at room temperature 1 year under refrigeration Price $104 (US) ~ 300 Euros, US pricing not known
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Allergic contact dermatitis to methylaminolevulinate after photodynamic therapy The risk of developing contact allergy to Hohwy et al Contact Dermatitis 2007: 57: 321–323 contact allergy to Metvix in PDT-treated patients was calculated to be 1%.
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