New treatment will help GPs tackle sun damage that can lead to skin cancer

Picato (ingenol mebutate) gel is a topical treatment licensed for the cutaneous treatment of non-hyperkeratotic, non-hypertrophic actinic keratosis (AK) in adults, a type of skin damage caused by long-term sun, or UV exposure, that has the potential to progress to the non-melanoma skin cancer, squamous cell carcinoma (SCC).

Current topical, patient-applied therapies have treatment durations from three weeks up to three months, longer treatment durations can lead to levels of patient adherence as low as 37 per cent. Picato® effectively manages actinic keratosis with a once-daily treatment, which is applied over two or three days and demonstrates high patient adherence in clinical trials of over 98 per cent.

Actinic keratosis often appears as red, rough, sandpapery patches of skin on areas that are more exposed to sun, such as the face, head, arms and legs. It can occur as a single lesion or multiple lesions affecting an entire area (known as the ‘field’). Where there are multiple lesions, it is important to treat the entire field. Picato® is a field-directed topical gel, indicated for the treatment of non-hyperkeratotic, non-hypertrophic actinic keratosis in adults.

An extensive phase III clinical trial programme has demonstrated that, three days’ treatment application with Picato® 150mcg/g on the face or scalp led to an 83 per cent median reduction in the number of AK lesions compared to baseline, when measured at day 57. Following two days’ treatment application on the trunk or extremities with Picato® 500mcg/g, there was a 75 per cent median reduction in the number of AK lesions compared to baseline, when measured at day 57.

Commenting on the launch, Dr Tony Downs, Consultant Dermatologist, Royal Devon and Exeter Hospital, said, “The launch of Picato® in the UK is a very positive step forward for both patients living with actinic keratosis, and GPs and dermatologists treating the condition. As it is impossible to predict which actinic keratosis lesions will advance to non-melanoma skin cancer, early detection and effective treatment is very important.”

In March this year, the Scottish Medicines Consortium (SMC) accepted Picato® for use in Scotland. NICE recently published an Evidence Review Summary for ingenol mebutate gel (ESNM14) which recognised that the simple dosing regimen and the short duration of the treatment course compared with other self-applied, field-directed agents (with side effects peaking after treatment is completed) may be beneficial in terms of adherence to treatment.

Dr Stephen Kownacki, Executive Chair of the Primary Care Dermatology Society (PCDS) said, “Actinic keratosis is a condition that in the majority of cases can be managed and treated effectively in primary care, avoiding unnecessary referrals. When treatment is needed, Picato® provides GPs and their patients with an effective and fast treatment to address this potentially pre-cancerous condition.”

Patients are likely to develop local skin responses (LSRs) following treatment with topical therapies for actinic keratosis. The development of LSRs following treatment with Picato® are typically of same day onset and predictable over time and typically resolve within 2–4 weeks depending on body location causing less inconvenience to the daily life of patients.

Dr Tony Downs added, “The key to effective actinic keratosis management is adherence to treatment. There is every reason that the high compliance levels seen in the clinical trials can be replicated in the primary care setting. Better compliance will result in the ultimate goal of improved outcomes for patients.”

Every year there are more new cases of skin cancer in the UK than breast and lung cancers combined. Worldwide, the number of patients with actinic keratosis is rapidly growing, especially in Europe, the US and Australia. In the UK, approximately one in five patients aged 60+ years have one or more actinic keratosis lesions.

Charlotte Fionda, Director of Skcin, the UK's only national skin cancer-specific charity, said, “Sadly, public awareness of the dangers of overexposure to UV light is very poor and the incidence of skin cancer and potential pre-cursors such as actinic keratosis is on the rise. It is now more important than ever for the general public to be skin savvy and check their skin for any changes.”

Ingenol mebutate, the active ingredient in Picato® is derived from the sap of the plant Euphorbia peplus (also known as E. peplus). The product has been developed as a new treatment for actinic keratosis following an extensive and complex manufacturing and clinical programme over many years.

Geraldine Murphy, Managing Director of LEO Pharma UK/IE, commented, “LEO Pharma UK/IE is committed to providing total care solutions to people living with skin disease and the launch of Picato® in the UK and Ireland is a significant advance for patients suffering from actinic keratosis. Actinic keratosis can lead to non-melanoma skin cancer and is a growing problem throughout the world. This launch of Picato® in the UK is another step forward towards our goal of helping people achieve healthy skin.”

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Drug Trials  •  Pharmacology/ Therapeutics


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