Photodynamic Therapy (PDT) With Metvix Cream 160 mg/g Versus PDT With Placebo Cream in Participants With Primary Nodular Basal Cell Carcinoma

A Multicenter, Phase III, Double Blind Study of Photodynamic Therapy (PDT) With Metvix 160 mg/g Cream in Comparison to PDT With Placebo Cream in Patients With Primary Nodular Basal Cell Carcinoma

Photodynamic therapy (PDT) was the selective destruction of abnormal cells through light activation of a photosensitiser in the presence of oxygen. These cells accumulated more photosensitiser than normal cells. The photosensitiser generated reactive oxygen species upon illumination.

For skin diseases, there had been an increasing interest in using precursors of the endogenous photosensitiser protoporphyrin IX (PpIX). The most commonly used precursors have been 5-aminolevulinic acid (ALA) and its derivatives. The present test drug, Metvix, contained the methyl ester of ALA, which penetrated the lesions well and shows high lesion selectivity.

In vitro studies of animal and human tissues had shown significant intracellular formation of photoactive porphyrins after addition of Metvix. The increased photoactive porphyrins levels induced cytotoxic effects in tumour cells after photoactivation.

The primary objective was to compare PDT with Metvix cream to PDT with placebo cream in terms of participants complete response rates based on histologically verified disappearance of the lesions at 6 months after last treatment cycle. Secondary objectives was to compare the two treatments in terms of histological and clinical mean participant response weighted by the number of lesions within a participant, lesion response rates across participants, clinical complete participant response, cosmetic outcome and adverse events.

Study Overview

• Status: Completed
• Conditions: Basal Cell Carcinoma
• Intervention / Treatment: Drug: Placebo Cream; Radiation: Photodynamic Therapy (PDT); Drug: Metvix cream

Detailed Description

A participants were randomised to PDT with Metvix cream or PDT with placebo cream. All eligible basal cell carcinoma (BCC) lesions within a participant received same treatment. All participants received two consecutive treatments one week apart. At the 3-months follow-up visit, lesions with no clinical response or progression were surgically excised. Lesions with partial response 50 percent (%) or greater reduction on lesion area) were re-treated; if they do not show complete response three months later, they were surgically excised. Lesions with complete response were surgically excised 6 months after the first or second PDT cycle. All excised tissue specimens were histologically examined.

• Study Type: Interventional
• Enrollment (Actual): 65
• Phase: Phase 3

Contacts and Locations

Study Locations

• United States
  • California
    • Santa Monica, California, United States, 90404-2115
      • Clinical Research Specialists Inc
  • Minnesota
    • Minneapolis, Minnesota, United States, 55455
      • Department of Dermatology, University of Minnesota Hospital and Clinic
    • Rochester, Minnesota, United States, 55905
      • Department of Dermatology, Mayo Medical School, Mayo Clinic
  • New Mexico
    • Albuquerque, New Mexico, United States, 87106
      • Academic Dermatology Associates
  • New York
    • Buffalo, New York, United States, 14263
      • Department of Dermatology, Roswell Park Cancer Institue
  • Oregon
    • Portland, Oregon, United States, 97210
      • Northwest Cutaneous Research Specialists
  • Texas
    • Austin, Texas, United States, 78759
      • Dermresearch, Inc.
    • Dallas, Texas, United States, 75230
      • Texas Dermatology Research Institute
  • Virginia
    • Norfolk, Virginia, United States, 230507
      • Virginia Clinical Research, Inc.

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

A participant with primary, nodular BCC lesion(s) suitable for entry is defined as a participant with

• Clinically diagnosed primary nodular BCC lesion(s).
• Histologically confirmed diagnosis of BCC.
• BCC lesions suitable for simple excision surgery.
• Males or females above 18 years of age.
• Written informed consent.

Exclusion Criteria:

A participant that is ineligible for inclusion is a participant fulfilling any of the following criteria:

• Participants with porphyria.
• Participants with Gorlin's syndrome.
• Participants with Xeroderma pigmentosum.
• Participants concurrently receiving immunosuppressive medication.
• Participants with a history of arsenic exposure.
• Participants with BCC arising in a previous radiated area.
• Known allergy to Metvix, a similar PDT compound or excipients of the cream.
• Participation in other clinical studies either concurrently or within the last 30 days.
• Pregnant or breast-feeding: All women of child-bearing potential must use adequate contraception (e.g. barrier methods, oral contraceptives or intrauterine device) during the treatment period and one month thereafter. In addition, they must have a negative pregnancy test prior to treatment..
• Conditions associated with a risk of poor protocol compliance.

Lesion Exclusion Criteria:

• A nodular BCC lesion in periorbital area, ears and nasolabial fold.
• A nodular BCC lesion with the longest diameter less than 6 millimeter (mm) or larger than 15 mm in face/scalp, larger than 20 mm on extremities and neck and larger than 30 mm on truncus.
• Pigmented nodular BCC lesion(s)
• Morpheaform nodular BCC lesion(s).
• Infiltrating nodular BCC lesion(s).
• Prior treatment of the BCC lesion(s).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Photodynamic Therapy (PDT) WIth Metvix Cream 160 milligrams/gram (mg/g); Participants with BCC lesions were administered to PDT with Metvix® cream 160 mg/g applied topically for three hours, followed by illumination using noncoherent light with a fluency of 75 Joule per centimeter square (J/cm*2) and fluency rate of less than 50-200 milliwatt per centimeter square (mW/cm*2) up to 14 weeks. All participants received two consecutive treatments, one week apart thereby completing one PDT treatment cycle.	Radiation: Photodynamic Therapy (PDT); Drug: Metvix cream
Placebo Comparator: Placebo Cream; Participants with BCC lesions were administered to PDT with Placebo cream applied topically for three hours, followed by illumination using noncoherent light with a fluency of 75 J/cm*2 and fluency rate of 50-200 mW/cm*2 up to 14 weeks. All participants received two consecutive treatments, one week apart thereby completing one PDT treatment cycle.	Drug: Placebo Cream; Radiation: Photodynamic Therapy (PDT)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants With Histologically Confirmed Complete Response	The histological complete response was defined as 100 percent (%) of the lesions within the participant having negative findings in the histological examination. Histological examination included evaluation of all the microscopical slides from the excised tissue for presence of malignant basal cells. Complete response was defined as complete disappearence of lesion. Number of participants with histologically confirmed complete response were reported.	up to 9 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Lesions With Histologically Confirmed Complete Lesion Response	Histological response weight means no signs of malignant basal cells in all microscopical slides containing excised tissue. The histologically confirmed complete lesion response were reported.	up to 9 months
Percentage of Lesions With Clinically Confirmed Complete Lesion Response	Clinically confirmed complete lesion response means no signs of malignant basal cells in all microscopical slides containing excised tissue. The clinically confirmed complete lesion response were reported.	up to 9 months
Histological Verified Lesions With Complete Response	Histological confirmed complete lesion response means no signs of malignant basal cells in all microscopical slides containing excised tissue. Number of histologically confirmed lesions with complete response were reported.	up to 9 months
Clinically Verified Lesions With Complete Response	Clinically confirmed complete lesion response means no signs of malignant basal cells in all microscopical slides containing excised tissue. Number of clinically confirmed lesions with complete response were reported.	up to 9 months
Number of Participants With Clinically Evaluated Complete Response	The on-site investigator evaluated the lesion response by comparing to the lesion size before and after treatment. Complete response here means complete disappearance of a lesion. Number of participants for whom one or more lesions had a complete response were reported.	up to 9 months
Number of Participants With Cosmetic Outcome Assessed by Investigator and Participants	Cosmetic outcomes were assessed with regards to occurrence of the following signs or symptoms; scarring, atrophy, induration, redness or change in pigmentation. Cosmetic outcome were graded as excellent, good, fair or poor where: excellent: no scarring, atrophy or induration, no or slight occurrence of redness or change in pigmentation compared to adjacent skin; good: no scarring, atrophy or induration but moderate redness or change in pigmentation compared to adjacent skin; fair: slight to moderate occurrence of scarring, atrophy or induration and Poor: extensive occurrence of scarring, atrophy or induration. The investigator and participants assessed the cosmetic outcome for each lesion has responded completely. Participants were asked to evaluate evaluate the cosmetic outcome according to the same categories: excellent, good, fair cosmetic outcome. Number of participants with summarized cosmetic outcomes for all symptoms as assessed by Investigator and participants were reported.	up to 9 months
Number of Participants With Adverse Events and Serious Adverse Events (AEs)	Adverse event (AE) was defined as any untoward medical occurrence in a participant, which does not necessarily have causal relationship with treatment. A serious AE was defined as an AE that resulted in any of the following outcomes: death; life threatening; persistent/significant disability/incapacity; initial or prolonged in participant hospitalization; congenital anomaly/birth defect or was otherwise considered medically important. TEAEs: events between first dose of study drug that were absent before treatment/that worsened relative to pre-treatment state. TEAEs included both serious TEAEs and non-serious TEAEs. Number of participants with AEs and serious AEs were reported.	up to 6 months

Collaborators and Investigators

• Sponsor: Galderma R&D
• Investigators: Principal Investigator: Whitney Tope, MPhil, MD, University of Minnesota Hospital and Clinic

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2000
• Primary Completion (Actual): April 1, 2002
• Study Completion (Actual): April 1, 2002

Study Registration Dates

• First Submitted: May 10, 2007
• First Submitted That Met QC Criteria: May 10, 2007
• First Posted (Estimated): May 11, 2007

Study Record Updates

• Last Update Posted (Actual): August 5, 2024
• Last Update Submitted That Met QC Criteria: February 28, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Keywords: Basal Cell Carcinoma; Nodular Basal Cell Carcinoma; PDT with Metvix 160 mg/g cream; PDT with placebo cream; Histological verification
• Additional Relevant MeSH Terms: Neoplasms by Histologic Type; Neoplasms; Neoplasms, Glandular and Epithelial; Neoplasms, Basal Cell; Carcinoma; Carcinoma, Basal Cell; Photosensitizing Agents; Dermatologic Agents; Methyl 5-aminolevulinate
• Other Study ID Numbers: PC T307/00