Interview conducted by April Cashin-Garbutt, BA Hons (Cantab)
Please can you give a brief overview of the ‘Physician Perceptions and Experience of Current Treatment in Actinic Keratosis’ global study?
Firstly, actinic keratosis (AK) is a common dermatological condition caused by cumulative exposure to the sun. Providing patients with effective treatment is very important, as AK can lead to forms of non-melanoma skin cancer (NMSC) if not diagnosed and treated early. In fact, two in three cases of squamous cell carcinoma (a common form of skin cancer), begin as AK.
The condition is characterised by visible skin lesions which co-exist with invisible (sub-clinical) lesions. There are a number of treatment options available, including topical therapy such as gels or creams which are applied to the affected area of skin.
Topical therapy is an important treatment modality for AK lesions, although there are some challenges and limitations with topical treatment options available currently, as some therapies have long durations and complex regimens, which can contribute to poor patient adherence to treatment.
Combined approaches to treatment, such as lesion-directed therapy in conjunction with field-directed topical therapies, have also been shown to improve clearance rates of AK.
This new study was designed to explore real-world experiences and perceptions of physicians around the world in terms of current topical therapies and how they impact adherence and patient outcomes.
A total of 537 physicians took part in the study across eight countries including the US, Brazil, Australia, Germany, UK, Italy, France and Spain.
The study is the first of its kind to look at physician treatment perceptions in actinic keratosis (AK). Why is this study being undertaken now?
One of the main reasons for conducting this study is that there has been a notable lack of research to date on how adherence to specific topical therapies impact on real-world efficacy.
For example, many current topical therapies are commonly associated with skin responses due to the way these treatments work. These responses can vary in timing and severity and have an impact on whether patients can tolerate the treatment for the required duration.
Similarly, treatment durations for topical therapies can vary significantly, often from a few days to several months. Patients may not be able to tolerate skin responses for longer periods and may choose to discontinue therapy, thus potentially reducing real-world efficacy.
It is important that we understand how these issues affect patients, so we can ensure we are providing the required support to enable people to get the maximum benefit from the range of treatments on offer.
What are the main concerns physicians have about AK therapies?
One of the key perceptions highlighted by the study was that over 70% of physicians felt that adherence and persistence was negatively influenced by long treatment duration. This was an important finding as it informs us that patients may not be achieving the full clinical benefit from the range of currently available topical treatments. As developers of new medicines, it tells us that we should look to provide therapies with short duration of treatment to meet the needs of patients
Duration and severity of skin responses were also thought by physicians to play significant roles in non-adherence. Our experience of working in this therapy area tells us that supporting healthcare professionals in providing patients with education on what to expect with a particular treatment is important to help manage their expectations.
Did the global study reveal how important physicians consider field therapy to be in treating AK?
The insights physicians gave on the importance of field therapy were intriguing – 80% felt that “field treatment is essential” for the majority of AK patients. This clearly reinforces the view in the current literature that field-directed therapies, which treat both the visible and sub-clinical AK lesions in an area of sun damaged skin, can lead to improved clearance and lower recurrence rates – both of which are key measures of patient clinical benefit.
Similarly, approximately three-quarters of physicians believed that topical therapy was the best form of field therapy.
The findings of the study were reviewed by a global dermatology panel. What recommendations for AK treatment did the panel suggest based on the study?
One of the key recommendations from the panel was that more should be done to ensure that physicians understand that AK can develop into squamous cell carcinoma (SCC) – a form of non-melanoma skin cancer. Through identifying and treating AK early, we believe that this will play a key part in alleviating some of the burden on the healthcare system caused by skin cancers.
Another important recommendation was that topical treatments with short treatment durations and high clinical efficacy should be prioritised. Providing patients with shorter treatment durations could reduce the time that patients endure the effects of treatment.
How important is the early detection of AK in the prevention of Squamous Cell Carcinoma (SCC)?
It is important that AK is detected and treated early to prevent the development of non-melanoma skin cancers such as SCC. Two in three cases of SCC begin as AK. However, as it is not possible to predict which lesions have the potential to become cancerous, it is important to treat all AKs.
Consequently, as shown in this new study, physicians demonstrate preference for topical field therapy as it is one of the treatment approaches that is capable of clearing both clinical and sub-clinical AK lesions.
In addition, experts recommend that patients conduct regular self-skin checks and request skin examinations from their physicians to improve AK detection rates. As such, LEO Pharma actively conducts patient awareness, education and support initiatives around the world for people living with AK, to help them achieve healthy skin.
How does LEO Pharma plan to use the information on physician treatment perceptions in AK to improve its therapies in development?
LEO Pharma is committed to the delivery of care solutions that empower people to better manage their AK and live confidently. We welcome the findings of this important study and are currently incorporating the learnings into the way we develop and optimise our treatments for AK, but also in our conversations with physicians in order to help them improve patient expectations from treatments.
What do you think the future holds for AK therapies?
I think the physician perceptions that were captured in this study highlight a key feature of what the future holds for AK therapies.
70% of physicians felt that adherence was negatively influenced by long treatment durations, and as such, dermatology care providers such as LEO Pharma respond to these unmet needs and provide therapies which better meet the needs of patients. For example, we have recently launched Picato® (ingenol mebutate gel), which is a short duration topical treatment for AK which only needs to be applied for 2 or 3 days, depending on the area of skin treated.
By listening to, and involving, people with skin conditions and healthcare providers in our innovation process, LEO Pharma ensure that our care solutions are based on real-life patient needs.
Where can readers find more information?
Readers can find out more at www.leo-pharma.com.
About Kim Kjøller
Senior Vice President, Global Development, LEO Pharma
Kim Domela Kjøller has been acting as Senior Vice President of Global Development at LEO Pharma since July 2011. Kim is originally from Copenhagen in Denmark and joined LEO Pharma in March 2010 as Corporate Vice President.
Prior to joining LEO Pharma, Kim held several roles with prominent pharmaceutical companies such as Sanofi Pasteur MSD, where he was involved in the start-up of Sanofi Pasteur MSD Denmark, and also Lundbeck, where he was Divisional Director within Strategic Marketing for Lundbeck’s mood disorder assets.
Kim’s career in the pharmaceutical industry spans approximately 15 years. Prior to this, Kim held scientific roles at The Danish Cancer Society and Copenhagen University Hospital following his graduation from Copenhagen University Hospital with a Medical degree.