Retinoids, the natural and synthetic analogs of
vitamin A, and
alpha-interferon have been used effectively in the treatment of certain cutaneous premalignancies and
malignancies.
Retinoids have shown impressive activity against premalignant disorders of the skin (
actinic keratoses,
keratoacanthoma,
epidermodysplasia verruciformis) and of other epithelial sites (
oral leukoplakia,
cervical dysplasia). In established basal cell
skin cancers, topical
retinoid treatment has produced a complete response rate of 33%, and systemic
retinoids have produced an objective response rate of 51%. In advanced squamous cell
skin cancers, systemic
retinoids have produced a response rate of over 70%. Intralesional
alpha-interferon has produced impressive responses and systemic
alpha-interferon has produced a 50% objective response rate in basal and
squamous cell carcinoma.
Retinoid therapy and
alpha-interferon have produced modest overall results in
melanoma, although striking individual responses have been reported. In
cutaneous T-cell lymphoma, which is notably refractory to
chemotherapy,
retinoids and
alpha-interferon have produced responses in 60%+ and 70%+ of cases, respectively.
Retinoids and
alpha-interferon, either alone or in combination, offer exciting prospects for primary and
neoadjuvant therapy for advanced
malignancy.
Retinoids also show promise as relatively nontoxic preventive and adjuvant
therapy. Researchers should focus on integrating these drugs with other
biological response modifiers, differentiation agents, and cytotoxic drugs for treating advanced
malignancy.