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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses the rationale for using methyl aminolevulinate cream (MAL) and exposure to sunlight (daylight photodynamic therapy) as an alternative for MAL and conventional photodynamic therapy to treat actinic keratoses.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EDermatology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESkin Cancer\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESoft Tissue Cancers\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EDermatology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDermatology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESkin Cancer\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESoft Tissue Cancers\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ERolf-Markus Szeimies, MD, PhD, Klinikum Vest Academic Teaching Hospital, Recklinghausen, Germany, discussed the rationale for using methyl aminolevulinate cream (MAL) and exposure to sunlight (daylight photodynamic therapy [DL-PDT]) as an alternative for MAL and conventional photodynamic therapy (c-PDT) to treat actinic keratoses (AKs). Although AKs of the scalp and face respond very well to c-PDT, the procedure is associated with pain and inconvenience [Rubel DM et al. \u003Cem\u003EBr J Dermatol\u003C\/em\u003E. 2014; Kennedy JC, Pottier RH. \u003Cem\u003EJ Photochem Photobiol B.\u003C\/em\u003E 1992]. Previously published data from a series of studies [Wiegell SR et al. \u003Cem\u003EBr J Dermatol\u003C\/em\u003E. 2012; Wiegell SR et al. \u003Cem\u003EBr J Dermatol\u003C\/em\u003E. 2011; Wiegell SR et al. \u003Cem\u003EBr J Dermatol\u003C\/em\u003E. 2009; Weigell SR et al. \u003Cem\u003EBr J Dermatol\u003C\/em\u003E. 2008] and an international consensus paper [Wiegell SR et al. \u003Cem\u003EJ Eur Acad Dermatol Venereol\u003C\/em\u003E. 2012] all suggest that even in Scandinavian countries, DL-PDT is an effective, safe, and more convenient alternative to MAL-PDT as a treatment for many people with AKs.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EProf Szeimies reviewed data from the Intra-individual Comparison of Efficacy and Safety of Metvix Natural Daylight Photodynamic Therapy Versus Conventional Metvix Photodynamic Therapy in Subjects With Mild Actinic Keratoses trial [COMET-1; Rubel DM et al. \u003Cem\u003EBr J Dermatol\u003C\/em\u003E. 2014] and the Phase 3b Study of Metvix NDL-PDT Versus Metvix c-PDT in Subjects With Actinic Keratoses [COMET-2; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01821391\u0026amp;atom=%2Fspmdc%2F14%2F37%2F11.atom\u0022\u003ENCT01821391\u003C\/a\u003E]. Both were randomized, phase 3, noninferiority studies of patients with mild (COMET-1) or mild-to-moderate (COMET-2) AKs.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ECOMET-1 included 100 Australian adults, and COMET-2 included 108 European patients. In both trials, patients were randomized to a single treatment of DL-PDT to either side of the face and c-PDT plus sunscreen to the other side. They were all followed for an initial 12 weeks; lesions that responded completely after the first 12 weeks were then followed for an additional 12 weeks. The primary efficacy outcome was complete AK lesion response rate per side at week 12. The primary safety end point was the self-reported pain assessment using the Visual Analog Scale (VAS) just after the treatment session at the baseline visit.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EIn both trials, the majority of patients were men. All were white with a mean age ranging from 67 to 73 years. The mean number of lesions on both sides at baseline in COMET-1 was 14, and it was 9 in COMET-2. At week 12, DL-PDT was noninferior to c-PDT in either trial (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). In COMET-1, 97% of the lesions that had completely responded at week 12 remained clear after 24 weeks; data were not presented for COMET-2. Prof Szeimies noted that DL-PDT was effective in either sunny or cloudy weather, with a similar rate of complete lesion response at 3 months after 1 session, but emphasized that the procedure will not be successful in rainy weather.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/37\/11\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Primary Efficacy End Point at Week 12\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1997208242\u0022 data-figure-caption=\u0022Primary Efficacy End Point at Week 12\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/37\/11\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/37\/11\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/37\/11\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12110\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EPrimary Efficacy End Point at Week 12\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EAK, actinic keratosis; c-PDT, conventional photodynamic therapy; DL-PDT, daylight photodynamic therapy.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from RM Szeimies, MD, PhD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EProf Szeimies went on to discuss the primary safety end point. The VAS scores were 0.8 and 7.7 (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001) with DL-PDT and c-PDT, respectively, in COMET-1 and were 0.7 and 4.4 (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001), respectively, in COMET-2. In COMET-1 and COMET-2, 82% and 91% of patients respectively treated with DL-PDT did not report any pain. In COMET-1, patients were more highly motivated to consider retreatment with DL-PDT than the conventional treatment (93% vs 63%); data were not available for COMET-2.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EIn summary, data from Australia and Europe suggest that DL-PDT is noninferior to c-PDT in treating mild and moderate AK and that the efficacy is sustained throughout at least 24 weeks for either procedure. Patients reported less pain when they underwent DL-PDT, expressed satisfaction with the procedure, and were motivated to seek out retreatment if necessary.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/37\/11.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzooy1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzooy1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}