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Imiquimod for the Treatment of Basal Cell or Squamous Cell Carcinoma: A Review of Clinical Effectiveness and Cost-Effectiveness

Published on: September 11, 2017
Project Number: RC0918-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of imiquimod for the treatment of basal cell or squamous cell carcinoma?
  2. What is the cost-effectiveness of imiquimod for the treatment of basal cell or squamous cell carcinoma?

Key Message

A network meta-analysis including patients with basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and Bowen’s disease (in situ SCC) and comparing treatments with imiquimod (IMQ), photodynamic therapy (PDT), surgical excision, cryotherapy (CTx), radiotherapy (RTx), fluorouracil (FU), and placebo showed that for complete lesion clearance, surgical excision was the most favorable followed in order by IMQ, CTx, PDT, FU and placebo; for cumulative recurrence probability, surgical excision was the most favorable followed in order by RTx, FU, IMQ, CTx, PDT; and for adverse events, placebo and CTX were the most favorable (least probability of occurrence of adverse events), followed in order by surgical excision, FU and IMQ.One randomized controlled trial (RCT) showed that for patients with BCC the success rate (i.e., no initial treatment failure or recurrence) up to 5 years of follow-up was higher with surgical intervention compared with IMQ treatment. One RCT showed that that for patients with superficial BCC, greater tumor free survival was achieved with IMQ compared with PDT, up to three years of follow-up.From one study conducted in the Netherlands and based on one year follow-up results, IMQ and FU were more cost-effective than MAL-PDT for treatment of superficial BCC.Findings need to be interpreted in the light of limitations (mainly variability across the studies with respect to population, follow-up times and lesion type).

Tags

cancer, dermatology, carcinoma, basal cell, neoplasms, squamous cell, Aldara, Zyclara