BACKGROUNDBasal cell carcinoma (BCC) is the most common skin cancer. Surgical excision remains the standard of treatment, but several alternative treatment modalities exist.OBJECTIVESThis review aims to provide a current analysis of evidence for the treatment of BCC; specifically, which treatments have the lowest recurrence rates and the best cosmetic outcomes.METHODSWe searched PubMed (January 1946 to August 2013), Ovid MEDLINE (2003-August 2013), the Cochrane Central Register of Controlled Trials (January 1993 to August 2013), and the Cochrane Database of Systematic Reviews (The Cochrane Library Issue 9, 2013) databases for randomized controlled trials, systematic reviews, or comparative studies for the treatment of BCC.RESULTSWe found 615 potential articles. Two independent reviewers selected 40 studies: 29 randomized controlled trials (RCTs), seven systematic reviews, and four nonrandomized prospective trials. Treatment modalities reviewed include surgical therapy, radiotherapy and cryotherapy, photodynamic therapy (PDT), topical imiquimod, topical 5-fluorouracil (5-FU), topical solasodine glycoalkaloids, topical ingenol mebutate, intralesional 5-FU, intralesional interferon (IFN), and oral hedgehog pathway inhibitors.CONCLUSIONSThe available data suggest that surgical methods remain the gold standard in BCC treatment, with Mohs micrographic surgery typically utilized for high-risk lesions. Suitable alternate treatment options for appropriately selected primary low-risk lesions may include PDT, cryotherapy, topical imiquimod, and 5-FU. Radiotherapy is a suitable alternate for surgical methods for treatment in older patient populations. Electrodesiccation and curettage (ED&C) is a commonly used primary treatment option for low-risk lesions; however, there were no RCTs examining ED&C that met our inclusion criteria. New hedgehog pathway inhibitors are promising for the management of advanced BCC; however, side effects are a concern for some patients, and much remains to be learned regarding optimal treatment length, risk of recurrence, and potential development of resistance. There is insufficient evidence at present to make recommendations on topical solasodine glycoalkaloids, topical ingenol mebutate, and intralesional 5-FU and IFN-α. Overall continued research on the efficacy of treatment modalities is needed. In particular, studies should include histologic ascertainment of clearance, long-term follow-up, stratification based on tumor subtype, and comparison with surgical outcomes.

2012-03-01·Planta Medica3区 · 医学

Solasodine Rhamnosyl Glycosides Cause Apoptosis in Cancer Cells. Do They Also Prime the Immune System Resulting in Long-Term Protection against Cancer?

3区 · 医学

Article

作者: Chase, Tania Robyn ; Cham, Bill Elliot

Solasodine rhamnosyl glycosides (SRGs) induce apoptosis in a wide variety of cancer cells and are more effective than many well-established anticancer agents. Combination therapy of SRGs with cisplatin treats cisplatin-resistant cells such as lung cancer and breast cancer cells. Anticancer therapies with SRGs have been used intravenously, intraperitoneally, intralesionally, orally, and topically. Data is now presented that in addition to apoptosis and, perhaps as a consequence thereof, SRGs also have an effect of stimulating lasting immunity against cancer as shown with a mouse model and the terminal cancer Sarcoma 180. Mice were inoculated i. p. with Sarcoma 180. Groups of animals were administered SRGs half an hour after Sarcoma 180 inoculation. Mice treated with Sarcoma 180 but not with SRGs all died within 20 days. Four doses of SRGs caused total remission of Sarcoma 180 activity. Mice that went into remission were then reinoculated 20 days later with the cancer. Ten of twelve SRGs cured-animals were resistant to reinduction of terminal doses of the cancer. In comparison, twelve of twelve mice treated with SRGs without initial Sarcoma 180 activity but which were inoculated with Sarcoma 180 cells 20 days later, all died. In addition to apoptosis, SRGs stimulate lasting immunity against cancer. SRGs could play an important role in clinical management of diseases such a malignancy and also be used as a preventative therapy.

2012-01-01·Drug Discoveries & Therapeutics

Synthesis of solasodine glycoside derivatives and evaluation of their cytotoxic effects on human cancer cells

Article

作者: Xuesen Wen ; Jian Gao ; Hongxiang Lou ; Changzhi Cui ; Min Cui ; Bin Sun

Solasodine glycosides, such as solamargine, have been proved to be very important anti-cancer agents. In order to discover more potent cytotoxic agents and explore the preliminary structure activity relationship, a new series of solasodine glycosides 2-9 were synthesized via a transglycosylation strategy, and their cytotoxic activity against a panel of human cancer cell lines (MCF-7, KB, K562, and PC3 cells) were evaluated by MTT assays. The results indicated that compounds 2, 8, and 9 with the substitute moiety of rhamnose, 2-hydroxyethoxymethyl, and 1,3-dihydroxypropan-2-yloxy-methyl, respectively, exhibited quite strong anticancer activity. The underlying mechanism tests demonstrated that these compounds could induce apoptosis detected by DAPI staining, and Annexin V and propidium iodide binding. Cell cycle analysis indicated that the cancer cells were predominantly arrested at the G2/M phase when exposure to these compounds was examined by flow cytometry. These compounds may serve as lead candidates in the development of novel chemotherapeutics for cancer treatment.

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