title: Bowen's disease (squamous cell carcinoma in situ) in immunosuppressed patients treated with imiquimod 5% cream and a cox inhibitor, sulindac: potential applications for this combination of immunotherapy.
abstract: BACKGROUND
  Patients with chronic lymphocytic leukemia (CLL) often have a protracted course. However, all these patients are immunosuppressed and may have a high incidence of cutaneous malignancies.
  
  
  OBJECTIVE
  To determine if combination therapy using topical imiquimod cream 5% and the oral cyclooxygenase (COX) inhibitor are useful in the therapy of squamous cell carcinoma in situ (SCC in situ)/Bowen's disease in patients with long-standing CLL.
  
  
  METHODS
  Five CLL patients with head and neck cutaneous SCC in situ, which met criteria for Bowen's disease, were treated with topical 5% topical imiquimod cream and an oral COX inhibitor, sulindac 200 mg twice a day.
  
  
  RESULTS
  All patients showed clinical resolution and histologic clearing of the tumors after 16 weeks of therapy.
  
  
  CONCLUSIONS
  The local immune modulator, 5% imiquimod, in combination with a COX inhibitor, with its many potential antitumor effects may stimulate the innate and possibly the adaptive immune responses to clear these malignancies.
authors.affiliation: Department of Dermatology and Pathology, National Naval Medical Center, Bethesda, Maryland 20889-5600, USA. HSkelIII@aol.com
authors.forename: K J
authors.initials: KJ
authors.lastname: Smith
authors.forename: M
authors.initials: M
authors.lastname: Germain
authors.forename: H
authors.initials: H
authors.lastname: Skelton
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage*; D000287:Administration, Topical; D000368:Aged; D000634:Aminoquinolines / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001913:Bowen's Disease / Q000188:drug therapy*; D002278:Carcinoma in Situ / Q000628:therapy*; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D000077271:Imiquimod; D007165:Immunosuppression Therapy; D007167:Immunotherapy; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000188:drug therapy*; D009824:Ointments; D012878:Skin Neoplasms / Q000188:drug therapy*; D013467:Sulindac / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000276:Adjuvants, Immunologic; D000634:Aminoquinolines; D000970:Antineoplastic Agents; D016861:Cyclooxygenase Inhibitors; D009824:Ointments; D013467:Sulindac; D000077271:Imiquimod