Advantages and Uses

 

Clinical trials have demonstrated Metvix^® to be effective for the treatment of BCC lesions when compared to commonly used treatments, and more effective than the most commonly used standard treatment in the elimination of AK lesions, with a significantly superior cosmetic outcome. In addition, these trials have also demonstrated that Metvix^® has a mild, favourable and predictable side-effect profile.^{4, 9-12} Clinical trial results have proven the long-term efficacy and reliability of treatment for NMSC, demonstrating recurrence rates within the range of the standard treatments of cryotherapy and surgery.¹

 

Metvix^® is more selective than most conventional therapy. PAPs are preferentially accumulated within the lesion.⁷ The surrounding normal tissue is therefore minimally affected, leading to a reduced recovery period and a cosmetically superior result following the procedure.

 

Other effective treatments for BCC, AK or BD, such as surgery, cryotherapy and curettage work by non-selective cell destruction of the treated area, affecting both normal and abnormal tissue alike. This results in a greater potential for scarring or unsatisfactory cosmetic outcomes.^4,6

 

Metvix^® is a non-invasive therapy relying on external application of a selective photosensitising cream and an external light source for activation. This contributes to good patient acceptability and excellent cosmetic outcomes. Moreover, the technique can be administered by healthcare professionals with relatively modest investment in facilities and training.

 

Given its selective and non-invasive nature, Metvix^® treatment can be safely repeated if necessary to achieve higher response rates.⁸

 

Cosmetic outcome, defined according to the severity of scarring, atrophy or induration, and changes in pigmentation or redness, is an important consideration when treating superficial NMSCs, which generally respond well to treatment and have a good prognosis.

 

AK

Cosmetically sensitive areas such as the face are a common location for AKs and treatment choices should reflect this. In Phase III studies, Metvix^® in AK provided a consistently favourable cosmetic outcome, rated as 'excellent' by 83%, or 'excellent or good' by 96% and 97% of investigators.^6,9,11

The cosmetic outcome with Metvix^® was significantly superior to that achieved with cryotherapy after 3 months (96% vs 81% reported cosmetic outcome as 'excellent' or 'good' in a European multicentre study¹²; and 83% vs 51% showing 'excellent cosmetic outcome' in an Australian multicentre study ⁶).

 

sBCC

The risk of scarring is an important consideration when choosing therapy for sBCC owing to the high cure rates of therapies. Metvix^® appears to offer advantages over surgery and cryotherapy and this is especially important in the case of large, extensive and multiple lesions.

 

In a randomised comparator study, cosmetic outcome was superior for Metvix^® compared to cryotherapy at 3 months (89% vs 50% of patients rated as having 'good' or 'excellent' cosmetic outcome¹⁸).

 

Even in 'difficult to treat' populations 8, 17 (complex cases, with recurrent or large lesions, or lesions in the H-zone covering the nose and  peri-orificial areas of the face ) who might be expected to have poor cosmetic results, it was found that cosmetic outcome improved over time; for instance 76 % of patients had 'excellent' or 'good' cosmetic outcomes at 3 months, rising to 94% for complete responders after 24 months with Metvix^® in 'difficult to treat' cases of nBCC and/or sBCC.⁸

 

nBCC

nBCC lesions located outside the risk zone, and that are less than 2 mm in depth, are classed as low-risk. Hence the optimal treatment should provide a good cosmetic outcome combined with efficacy.

 

 

Metvix^® was superior to surgery with respect to cosmetic outcome in patients with nBCC. Investigators assessed the cosmetic outcome as 'excellent' or 'good' in about 80% of the patients treated with Metvix^® , while about 40% of the patients undergoing surgery were likewise classified.¹⁰  Even in patients with lesions in cosmetically sensitive areas,^8,17 cosmetic assessments with Metvix^® were favourable.

 

BD

In BD cosmetic outcome was objectively measured and found to be superior for Metvix^® compared with cryotherapy or 5-FU at 3 months¹⁴ (rated as 'excellent' or 'good' by 94%, 66%, and 76% of the patients, respectively). Cosmetic assessments improved over time and were still better than for cryotherapy after 12 months, 97% versus 62%.

As is the case with cosmetic outcome, the usually good prognosis of many NMSCs makes patient preference an important consideration when selecting therapy.

An analysis of 404 patients from 6 AK and BCC clinical studies using Metvix^® who were previously treated with therapies including cryotherapy, surgical excision and topical chemical therapy was performed. A preference for Metvix^® over their previous therapy was clearly demonstrated.¹³

 

The fact that the procedure is administered by a physician ensures good patient compliance. This provides more assurance of treatment optimisation and final outcome compared to therapies which rely on self-application of treatments by the patient.

 

A recent evaluation by the National Institute of Health and Clinical Excellence (NICE) (by clicking on this link you will be leaving this site - Galderma is not responsible for the content) in the UK supported use of this procedure for the treatment of BCC, BD and AK, with no major safety concerns.²² Treatment may be particularly appropriate for large, superficial lesions of BD, actinic keratosis and basal cell carcinoma, especially where there are multiple lesions and where repair would otherwise require extensive surgery.