In a nutshell
The authors analyzed the effectiveness of different skin-directed therapies for skin metastasis from advanced cancers.
Some background
Skin (cutaneous) metastasis is defined as the spread of cancer cells from the primary tumor to the skin. Based on reports, it is estimated that 5.3% of all cancer patients can develop skin metastasis. In addition, 45% of advanced melanoma patients, on average, develop skin metastasis. Skin metastasis can cause major side-effects such as infection, bleeding and pain. Systemic therapy (treatment that affects the whole body) has not been very effective in treating skin metastasis. Skin-directed therapy (local treatment affecting the skin only) has shown potential in reducing the severity of the symptoms experienced and improving overall response to treatments.
Methods & findings
The authors aimed to assess the effectiveness of skin-directed therapies for cutaneous metastasis from several clinical studies.
Overall, data from 4,313 cases of cutaneous metastases, from 47 studies, were analyzed. Five different skin-directed therapies were identified. These are as follows. Electrochemotherapy is the use of electrical pulses for increased absorption of chemotherapy. Photodynamic therapy uses light and a specific drug to treat cancer cells. Radiotherapy directs a beam of radiation at the tumor site to kill cancer cells. Intralesional therapy involves using a drug that is injected directly into the lesion (abnormal skin). Topical therapy uses specific medications that are applied directly on to the skin.
35.5% of patients experienced a complete response (all detectable tumor had disappeared after treatment). 60.2% of patients experienced a 50% reduction in tumor size or a complete response after treatment. The overall recurrence (return of the cancer) rate was 9.2%. Melanoma and breast cancer contributed to 96.8% of the primary cancers from which skin metastases developed from. The skin-directed therapies were well tolerated with severe and life-threatening side-effects reported in less than 6% of patients.
The bottom line
The fine print
Only 17% of the studies were randomized clinical trials. So, most likely, there was a bias in patient selection towards a specific type of skin-directed therapy. Therefore, factors such as tumor size, number of skin metastases and depth of tumors could not be standardized for the entire analysis.
Published By :
Journal of clinical oncology
Date :
Aug 25, 2014
