10.17.09 ~ 11.10 ~ Marmur ~ PDT Update

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

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Unformatted text preview: 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 Longpor 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 A chemotherapy for actinic keratoses 2 Stage Process 2 Stage Process Photosensitizer Photosensitizer Photoactivation Photoactivation 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 0.5 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 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...
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This note was uploaded on 02/23/2010 for the course ENGLISH 1011 taught by Professor Thompson during the Spring '07 term at Berkeley.

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

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