Patient case: 56-year-old female with basal cell carcinoma; genetic feature: PTCH1

Clinical trial: Blue vs Red Light During Levulan Based Photodynamic Therapy in Patients With Basal Cell Nevus Syndrome

Summary: The investigators will be testing whether aminolevulinate-based (Levulan™) Photodynamic Therapy (PDT) shows effectiveness in the treatment and prevention of cutaneous basal cell carcinoma (BCC) in Basal Cell Nevus Syndrome (BCNS) patients. Levulan™ PDT is an FDA-approved method widely used currently for squamous precancers of the skin. The investigators hypothesize that PDT will provide exceptional benefit in the BCNS population because PDT is nonmutagenic, nonscarring, and can be safely repeated many times. Additionally, the study will investigate whether there are any differences in tumor clearance between the Blu-U® (blue lamp) and Aktilite™(red lamp) therapies.

Detailed description: This is a pilot intra-patient comparative study to evaluate the ability of cyclic Photodynamic Therapy (PDT) using Red (635 nm) or Blue (400 nm) light with 5-Aminolevulinic acid, to eliminate BCC skin cancers that occur in patients with Basal Cell Nevus Syndrome (Gorlin-Goltz Syndrome).
  Patients will receive 3 cycles of Red light and Blue light PDT treatments, for a total of 6 treatments, over a 4 month period. Cycles will be spaced 2 months apart. Each cycle consists of a double course of PDT treatment with treatments spaced one week apart. Every subject will be treated with two light sources, blue and red, according to randomized assignments made to left side or right side of the body. There will be a final assessment visit at month 6.

Eligibility: Inclusion Criteria:
  -  Men, women, and children of any age or ethnic group who meet eligibility
  -  Patients under 18 years of age must be accompanied and co-consented, by a parent or legal guardian.
  -  Patients must have a diagnosis of Basal Cell Nevus Syndrome (BCNS)
  -  For diagnosis of BCNS, the patient must have either 2 major criteria, one major and two minor criteria, or one major criterion plus molecular confirmation of a PTCH1 gene mutation
  -  Major criteria are:
  -  (1) BCC prior to age 20 years, or excessive number of BCCs out of proportion to prior sun exposure and skin type
  -  (2) keratocyst of the jaw prior to age 20
  -  (3) palmar or plantar pitting
  -  (4) lamellar calcification of the falx cerebri
  -  (5) medulloblastoma
  -  (6) first degree relative with BCNS
  -  Minor criteria are:
  -  (1) rib anomalies, or other specific skeletal malformations including kyphoscoliosis and short 4th metacarpals
  -  (2) macrocephaly
  -  (3) cleft/lip or palate;
  -  (4) fibroma of the heart or ovary
  -  (5) ocular abnormalities
  -  (6) other rare abnormalities
  -  At least two BCC tumors, preferably more, located in different body regions or located greater than 10 cm apart in locations that can be reproducibly separated into red and blue illumination fields
  -  Female subjects are not pregnant or nursing or planning to become pregnant during the study
  -  Subjects must have the ability to understand and the willingness to sign a written informed consent document
  Exclusion Criteria:
  -  Pregnant, planning on getting pregnant or nursing
  -  Currently participating in another clinical trial
  -  Using any topical treatment for their BCC tumors, unless discontinued at least 1 month prior
  -  Currently being treated for other cancers with medical or radiation therapy
  -  Patients with a known hypersensitivity to 5-aminolevulinic acid or any component of the study material
  -  Patients with a history of a photosensitivity disease, including porphyria cutanea tarda

Relevance to patient case: definitely relevant