Site Editor
Soo Park, MD
Soo Park, MD
Posted: Tuesday, July 23, 2024
Topical imiquimod and radiotherapy are about equivalent in terms of efficacy and safety in treating lentigo maligna nonsurgically, according to the results of an international phase III trial by Angela M. Hong, MBBS, MMed, PhD, of Melanoma Institute Australia, Sydney, and colleagues. For some patients with this type of melanoma in situ, surgery is not an option because of comorbidities or the malignancy’s location or size. Based on these study results, presented during the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract 9502), there appeared to be no major difference in acute or long-term quality of life between the two treatments.
The trial’s primary endpoint was treatment failure within 24 months, and secondary endpoints included development of invasive disease within the area, adverse effects, and patient-reported quality of life (assessed with validated questionnaires). All participants (median age, 72) were not candidates for surgery, and 94.9% of lesions were in the head or neck area. Between 2015 and 2021, they were randomly assigned to receive imiquimod (n = 60) or radiotherapy (n = 58). Median follow-up was 27 months.
Median time to recurrence was not reached in either group. Although twice as many patients in the radiotherapy group developed recurrence within 24 months—12 vs 6 in the imiquimod arm—this was not considered to be a statistically significant difference (P = .063).
However, “treatment failure was significantly different within the subgroup of patients who had reflectance confocal microscopy follow-up of [their] lentigo maligna,” Dr. Hong and co-researchers noted. The treatment failure rate was 8.7% with imiquimod vs 25.0% with radiotherapy (P = .033). “Only one reflectance confocal microscopy feature was associated with failure at 24 months and significantly different between treatment groups: the presence of atypical round cells at the dermal-epidermal junction (6.9% of imiquimod failure and 27% of radiotherapy failure: P = .035),” they detailed.
Disclosure: For full disclosures of the study authors, visit coi.asco.org.
JNCCN Spotlights
