Topical medications for conjunctival tumors have pluses and minuses
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MONTEREY, Calif. — Interferon alpha-2b, 5-fluorouracil and mitomycin C can all be used topically for conjunctival tumors, Lauren A. Dalvin, MD, said at the Women in Ophthalmology Summer Symposium.
“Compared to surgical therapy, these do require more time; these do require reliable patient follow-up,” Dalvin said.
The medications can be used effectively as primary tumor treatment, chemoreduction before surgery or adjuvant therapy after surgery; however, insurance coverage can be challenging, she said.
“Interferon has always been my favorite because it is really well tolerated,” Dalvin said.
Interferon alpha-2b is a glycoprotein that acts at the cell surface; it can be used topically, with injections and subconjunctivally. This medication does not require a period of rest after treatment because “it is so gentle on the eye,” Dalvin said. It is growing more difficult to obtain, however, and it is expensive and difficult to get covered by insurance.
“Unfortunately, I think this is going by the wayside, but we’ve had some really nice results,” Dalvin said.
5-FU is an antimetabolite that interrupts DNA replication and cell growth.
“It’s kind of our middle-of-the-road option,” Dalvin said.
Her protocol is 5-FU four times daily for 1 week, then 3 weeks of rest before repeating the cycle. Side effects are moderate, it is generally well tolerated, and in the U.S., it tends to be a low-cost option, Dalvin said.
“My heavy-hitter drug is mitomycin C,” Dalvin said.
MMC is an alkylating agent that Dalvin uses four times per day for 1 week followed by a week of rest and repeated as needed. The drug is highly effective but often poorly tolerated.
“This is not a fun medication to use. Patients are really uncomfortable by the end of 7 days of using this medication,” Dalvin said.
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Dalvin LA. Medical therapy for conjunctival tumors: Local treatments. Presented at: Women in Ophthalmology Summer Symposium; Aug. 25-28, 2022; Monterey, California (hybrid meeting).
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