A review of Metvix for the treatment of actinic keratoses, superficial basal cell carcinoma and for use in daylight photodynamic therapy
Abstract
With increasing sun exposure and an aging population, skin malignancies dysplasia are becoming more prevalent. This includes premalignant actinic keratoses (AK), basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and other skin cancers. Many treatment options are available for these conditions, including cryotherapy, surgery, topical field therapy creams, and photodynamic therapy (PDT).
PDT utilizes a photosensitizing agent and visible light in the presence of oxygen to produce reactive oxygen species (ROS), which then induce apoptosis of cellular components leading to cell death. Conventional PDT (c-PDT) is approved in Canada for the treatment of non-hyperkeratotic actinic keratoses (AK) and superficial basal cell carcinoma (BCC) outside the H-zone of the face. It is also used off label for the treatment of squamous cell carcinoma in-situ (SCCis), which is an approved indication for PDT in many European countries. Daylight PDT (d-PDT) using methyl aminolaevulinate (MAL) for AK is also approved by Health Canada. In Canada, there are two approved topical photosensitizers: Levulan® Kerastick (5-Aminolevulinic acid or 5-ALA) (DUSA Pharmaceuticals Inc) and Metvix (MAL) (Galderma Canada Inc). Only Metvix is approved for the treatment of AK, superficial BCC and for the use in daylight PDT in Canada, and as such it is the focus of this article.
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