Current Practice in the Treatment of Epithelial and Melanocytic Tumours with Interferon-α2b: A Survey of Tertiary Eye Centres in Germany

Abstract

Purpose To evaluate the standard of care, in particular the use of topical or subconjunctival interferon-α2b, in treating ocular surface squamous neoplasia or melanocytic tumours in tertiary eye centres in Germany.

Methods A survey containing 14 questions was sent to 43 tertiary eye centres in Germany. The questions addressed the surgical and medical management of ocular surface squamous neoplasia and melanocytic tumours (primary acquired melanosis and malignant melanoma), as well as the clinical experiences and difficulties in prescribing off-label interferon-α2b eye drops and subconjunctival injections.

Results Twenty-four tertiary eye centres responded to the survey. Eighty-three percent of centres had used interferon-α2b in their clinical practice and 25% prescribed it as the first-line cytostatic agent following surgical excision of ocular surface squamous neoplasia, while 10% would do so for melanocytic tumours. Correspondingly, the majority of respondents selected mitomycin C as their first-line agent. Side effects were uncommon with topical interferon-α2b eye drops but were more frequently reported after subconjunctival interferon-α2b injections. In total, eight centres had experience with interferon-α2b injections. The most significant obstacles perceived by ophthalmologists when prescribing interferon-α2b were its high cost and the reimbursement thereof.

Conclusion Off-label mitomycin C was the preferred adjuvant therapy for epithelial and melanocytic tumours, with interferon-α2b being the standard second-line option. Interferon-α2b has predominantly been used to treat ocular surface squamous neoplasia and, to a lesser extent, melanocytic tumours at German tertiary eye centres. Following its market withdrawal, supply shortages of interferon-α2b are likely to have a profound impact on patient care and their quality of life.

Zusammenfassung

Ziel Evaluation des Therapiestandards, insbesondere der Verwendung von topischem oder subkonjunktivalem Interferon-α2b, bei der Behandlung von Neoplasien der plattenepithelialen, okulären Oberfläche oder melanozytären Tumoren der Augenoberfläche in tertiären Augenzentren in Deutschland.

Methoden Eine Umfrage mit 14 Fragen wurde an 43 tertiäre Augenzentren in Deutschland verschickt. Die Fragen befassten sich mit der chirurgischen und medizinischen Behandlung von Neoplasien der plattenepithelialen, okulären Oberfläche und melanozytären Tumoren (primär erworbene Melanose und malignes Melanom) sowie den klinischen Erfahrungen und Schwierigkeiten bei der Verschreibung von Off-Label Interferon-α2b-Augentropfen und subkonjunktivalen Injektionen.

Ergebnisse 24 tertiäre Augenzentren nahmen an der Umfrage teil. 83% der Zentren hatten Interferon-α2b eingesetzt und 25% verschrieben es als First-Line-Therapie nach chirurgischer Entfernung von Neoplasien der plattenepithelialen, okulären Oberfläche, wohingegen 10% dies bei melanozytären Tumoren angewendet hätten. Dementsprechend wählte die Mehrheit der Befragten Mitomycin C als Mittel der ersten Wahl aus. Nebenwirkungen waren bei topischen Interferon-α2b-Augentropfen selten, wurden aber häufiger nach subkonjunktivalen Interferon-α2b-Injektionen gemeldet. Insgesamt hatten 8 Zentren Erfahrungen mit Interferon-α2b-Injektionen. Die größten Hürden, die Augenärzte bei der Verschreibung von Interferon-α2b hinderten waren die hohen Kosten und deren Übernahme durch die Krankenkassen.

Schlussfolgerung Off-Label Mitomycin C war die bevorzugte adjuvante Therapie für epitheliale und melanozytäre Tumoren, während Interferon-α2b Standardoption für eine Zweitlinientherapie war. Interferon-α2b wurde in deutschen, tertiären Augenzentren vorwiegend zur Behandlung von Neoplasien der plattenepithelialen, okulären Oberfläche und in geringerem Maße von melanozytären Tumoren eingesetzt. Nach der Marktrücknahme von Interferon-α2b werden Lieferengpässe wahrscheinlich beträchtliche Auswirkungen auf die Patientenversorgung und ihre Lebensqualität haben.

Key messages

What is already known

• Off-label IFN-α2b was used to treat ocular surface tumours (neo)adjuvantly for many years with good efficacy and few side effects. However, it was withdrawn from the market in 2019.

• Little is known about the use of IFN-α2b to treat patients with melanocytic tumours or OSSN in Germany.

What this study shows

• Among tertiary eye centres in Germany, 25% of respondents prescribed IFN-α2b as the first-line cytostatic agent following surgical excision of OSSN, while 10% would do so for melanocytic tumours.

• The most significant obstacles to prescribing IFN-α2b were its high cost and the reimbursement thereof.

Key words

5-fluorouracil - mitomycin C - interferon-α2b - ocular surface squamous neoplasia - conjunctival melanoma

Schlüsselwörter

5-Fluorouracil - Mitomycin C - Interferon-α2b - Bindehautmelanom - Neoplasie der plattenepithelialen, okulären Oberfläche

Publikationsverlauf

Eingereicht: 22. Dezember 2022

Angenommen: 06. Februar 2023

Accepted Manuscript online:
06. Februar 2023

Artikel online veröffentlicht:
05. Mai 2023

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