Recently approved drugs manipulate immune response
When imiquimod 2.5 percent (Aldara, Medicis) is released commercially, "The real question will be, where does it fit?" Dr. Bhatia says. It might fit best as a step-down for maintenance treatment after treatments that capitalize on the field effect of imiquimod 3.75 percent.
"And there will be questions about whether imiquimod 2.5 percent is easier for treating broad surface areas, to minimize aggressive responses that result from stronger concentrations," says Dr. Bhatia, a Long Beach, Calif., dermatologist in private practice.
"The problem with 5 percent imiquimod was, where could it go without the treatment becoming too aggressive? When imiquimod 3.75 percent came out, its indication had more surface area. But it does not have any indication for solid tumors or warts," he explains.
Although he doesn't envision any additional clinical trials or indications for imiquimod, "There's a lot of potential for making imiquimod 3.75 percent work for solid tumors of the skin, such as basal cell carcinoma (BCC) and warts, as imiquimod 5 percent did," Dr. Bhatia says. "As long as imiquimod augments the targeted immune response against the specific antigen, it's going to do its job."