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American Journal of Clinical Dermatology
Published in: American Journal of Clinical Dermatology 2/2000

01-03-2000 | Adis New Drug Profile

Topical Aminolevulinic Acid HCl Photodynamic Therapy

Authors: Douglas Ormrod, Blair Jarvis

Published in: American Journal of Clinical Dermatology | Issue 2/2000

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Abstract

▴ Photodynamic therapy (PDT) is the treatment of tumors or dysplasic tissue with drugs that produce cytotoxic metabolites when exposed to light.
▴ Aminolevulinic acid HCl (5-aminolevulinic acid HCl; ALA) is a prodrug that is metabolized intracellularly to form the photosensitizing molecule protoporphyrin (PpIX). When PpIX is activated by light, cytotoxic reactive oxygen species and free radicals are generated.
▴ ALA can diffuse through skin and preferentially localizes in tumors and dysplasic tissue; subsequent exposure of PpIX-loaded tumor cells to light can destroy the tumor.
▴ After application of a 20% solution of ALA to actinic keratosis lesions of the head, PpIX (as measured by skin fluorescence) peaked 11 hours after treatment and the mean clearance half-life was 30 hours.
▴ In phase II trials 10 J/cm2 of blue light (wavelength = 417nm) delivered at 10 mW/cm2 for 1000 seconds was found to provide maximal therapeutic effect on lesions of the head after treatment with 20% ALA.
▴ In phase III trials of ALA PDT in 241 patients with lesions of the head 72% of patients had a complete response to treatment at 12 weeks versus 20% of those treated with vehicle and light alone. Some of these patients had been re-treated at 8 weeks.
▴ In these trials 12% of ALA-treated patients and 37.5% of those receiving vehicle whose lesions had cleared at 8 weeks had relapsed at 12 weeks. When the total number of lesions were considered the recurrence rate was 5 and 27.9% for ALA- and vehicle-treated lesions, respectively.
▴ All patients reported some degree of burning or stinging during PDT but this usually subsided after irradiation was completed and was rarely treatment-limiting. Localized erythema and edema were also common. No other significant adverse effects were noted and treatment was generally well tolerated.
▴ A well designed dermal applicator ensured perilesional skin was spared collateral damage.
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Metadata
Title
Topical Aminolevulinic Acid HCl Photodynamic Therapy
Authors
Douglas Ormrod
Blair Jarvis
Publication date
01-03-2000
Publisher
Springer International Publishing
Published in
American Journal of Clinical Dermatology / Issue 2/2000
Print ISSN: 1175-0561
Electronic ISSN: 1179-1888
DOI
https://doi.org/10.2165/00128071-200001020-00009

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