Most Read Articles
01 Oct 2013

Heart disease is still New Zealand’s biggest killer, with one Kiwi dying from coronary heart disease every 90 minutes. Pharmacy Today New Zealand looks at how pharmacists can help

Dr. James Salisi, 01 Jul 2014

The recent spike in the number of new cases of human immunodeficiency virus (HIV) infection in the Philippines means that clinicians and pharmacists alike may need to increase their awareness and competency in prescribing and monitoring HIV treatment. Although taught in medical and pharmacy schools, the scarcity in exposure to clinical cases before highlights the need to for physicians and pharmacist to review HIV pharmacotherapy in order to cater to the increasing HIV patient population.

01 Sep 2017
Complementary medicines can play an important part in maintaining wellness, preventing deficiencies and optimizing health outcomes, says Dr Lesley Braun PhD, Director of the Blackmores Institute. 
Audrey Abella, 16 Oct 2017
The use of angiotensin converting enzyme (ACE) inhibitors may prevent repeat revascularization in patients who underwent percutaneous transluminal angioplasty (PTA) for peripheral artery disease (PAD) compared with angiotensin receptor blockers (ARB), according to a presentation at APCH 2017.

Topical 1% 5-fluoruracil as sole therapy safe, effective for OSSN

Stephen Padilla
18 Aug 2017

Use of topical 1% 5-fluoruracil (5-FU) as a sole therapy has shown its long-term safety and efficacy in patients with preinvasive ocular surface squamous neoplasia (OSSN) and for a limited proportion of invasive OSSN, according to a study.

Researchers included 41 patients affected by OSSN, each of whom underwent full ophthalmological examination at baseline, with cytological or histological confirmation. Patients received topical chemotherapy with 1% 5-FU four times a day for 4 weeks (one course). Adjunctive courses were administered after 1 month of chemotherapy-free interval. Mean follow-up was 105 months.

“Our treatment strategy is characterized by one (30 days) or more courses followed by 30 days of no treatment between each course,” researchers said. “The standard dosage of topical 5-FU reported is 1% in aqueous solution, used four times a day over 4 weeks.” [Int Ophthalmol Clin 2015;55:9–21]

Thirty-four (83 percent) cases achieved complete tumour regression after a mean of 1.5 courses (range, one to three courses). Complete response was significantly associated with tumour thickness <1.5 mm (p=0.005), lack of fornix or tarsal involvement (p=0.015 and p0.009, respectively), and the absence of multifocality (p=0.002) based on univariate analysis. [Br J Ophthalmol 2017;101:1094-1099]

“We achieved a complete clinical and cytological regression in 83 percent of treated lesions, after a mean of 1.5 1% 5-FU courses, with the longest follow-up ever reported,” researchers claimed.

In addition, incomplete tumour response was associated with histopathological diagnosis (intraepithelial neoplasia vs squamous cell carcinoma; p=0.019) and American Joint Committee on Cancer (AJCC) classification (T1 vs T2 or T3; p=0.028). Multivariate analysis revealed that only tumour thickness >1.5 mm (p=0.045) and multifocality (p=0.023) correlated with incomplete tumour response.

Nineteen (48 percent) eyes experienced transient and reversible low-to-mild local side effects.

“In our population, only transient and reversible low-to-mild 5-FU local side effects were documented in 48 percent of treated patients, including superficial punctate keratitis and conjunctival hyperaemia, according to previous published data. Moreover, treatment was never discontinued due to these side effects,” researchers said.

Compared with standard surgical excision, topical chemotherapy has several advantages, including the treatment of the entire ocular surface, targeting of the tumour cells, simplicity of treatment, reduced cost associated with avoidance of the surgical approach and reduced patient morbidity. [Ophthalmology 2000;107:2190–5]

“A relevant concern in the use of topical chemotherapy is that some patients may not be fully compliant with drug administration timing and dosage,” researchers said. “Nevertheless, in our experience, no cases of clinically significant lack of compliance were documented.”

“The main clinical limitation of this treatment is elevated tumour thickness (>1.5 mm) and tumour multifocality. Nevertheless, further prospective studies are essential before recommending 5-FU as a sole treatment of invasive OSSN,” they added.

Preinvasive and invasive OSSN represent the most common primary tumours of the eye, and their spectrum is represented by conjunctival and corneal dysplasia and squamous cell carcinoma. The standard treatment modality for OSSN, with recurrence rates ranging from 5 to 69 percent, is surgical excision. [Surv Ophthalmol 1995;39:429–50; Ophthalmology 2012;119:1974–81]

A shift from surgery alone to the use of topical chemotherapeutic agents alone or as adjuncts, before or after surgery, has been seen in the last 20 years, according to researchers. [Int Ophthalmol Clin 2015;55:9–21]

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Most Read Articles
01 Oct 2013

Heart disease is still New Zealand’s biggest killer, with one Kiwi dying from coronary heart disease every 90 minutes. Pharmacy Today New Zealand looks at how pharmacists can help

Dr. James Salisi, 01 Jul 2014

The recent spike in the number of new cases of human immunodeficiency virus (HIV) infection in the Philippines means that clinicians and pharmacists alike may need to increase their awareness and competency in prescribing and monitoring HIV treatment. Although taught in medical and pharmacy schools, the scarcity in exposure to clinical cases before highlights the need to for physicians and pharmacist to review HIV pharmacotherapy in order to cater to the increasing HIV patient population.

01 Sep 2017
Complementary medicines can play an important part in maintaining wellness, preventing deficiencies and optimizing health outcomes, says Dr Lesley Braun PhD, Director of the Blackmores Institute. 
Audrey Abella, 16 Oct 2017
The use of angiotensin converting enzyme (ACE) inhibitors may prevent repeat revascularization in patients who underwent percutaneous transluminal angioplasty (PTA) for peripheral artery disease (PAD) compared with angiotensin receptor blockers (ARB), according to a presentation at APCH 2017.