Editorial

HeberFERON and life quality in face basal cell carcinoma

0000-0002-6889-5299Vladimir Sánchez Linares^{1  *}  , 0000-0003-0154-9137Iraldo Bello Rivero² 

¹Policlínico Centro, Sancti Spíritus, Cuba.

²Centro de Ingeniería Genética y Biotecnología, La Habana, Cuba.

Researches on health-related quality of life in dermatology is becoming increasingly frequent due to the negative effect that dermatoses (almost all with chronic course and impact on skin esthetics) have on the social, family, occupational and psychological spheres. ¹

The skin acts like a presentation letter as it is the most important organ for humans in terms of body image, so its condition is increasingly valued in society and its care takes time, both in women and men. The chronic, incurable and visible nature of dermatosis causes rejection and produces psychological changes, consequently, has a negative impact on life quality. ²

The World Health Organization (WHO) defines health-related quality of life as the value assigned to the life period modified by any damage, functional status, health perception and social opportunity due to a given disease, accident, treatment or policy. This value is individual and depends on the subjective perception of each person and his or her political, social and economic environment. Thus, life quality represents the functional effect of a disease and its treatment as perceived individually by the patient. To measure it, the WHO proposed the physical, functional, psychological and social health dimension. ^2,3

One of the skin disorders that negatively affects health-related quality of life (HRQoL) is the non-melanoma skin cancer together with basal cell carcinoma (BCC), which is the most frequent human tumor; its worldwide incidence has increased in recent decades and increasingly affects young people. BCC is a malignant neoplasm derived from epidermal cells of the hair follicles or non-keratinized cells that originate from the basal layer of the epidermis, of slow growth, but can be disfiguring and infiltrate the surrounding tissue, also not respond to existing therapies and become advanced so could result in serious deformities or loss of function of the affected organ, in addition to damage the facial aesthetics. 90 % of BCCs appear on the face and neck, and the most important factor for their appearance is exposure to sunlight. ⁴

When patients know they have skin cancer, they are affected because it involves changing their lifestyle, experiencing depression and associated symptoms, fears of changes in appearance, emotional, physical, aesthetic, functional concerns, long-term follow-up with constant anxiety and concern about tumor recurrence and scarring. ^4,5

Several factors contribute to the worsening of life quality in patients with BCC: the tumor and its location, size, ulceration, bleeding, surgical intervention and possible deformities, functional impairment, scarring and aesthetic and cosmetic problems; in non-surgical treatments adverse events. ⁵

Patients with basal cell carcinoma have a high risk of developing second primary BCC or tumor recurrence. 40 % of patients who develop their first basal cell carcinoma will develop at least one additional tumor within two years of diagnosis; therefore, it is considered a chronic disease that causes cosmetic, functional and emotional sequelae that affect quality of life. ^4,5)

Surgery is the support of BCC treatment, its main objective is to prevent recurrence, when performed with the corresponding oncologic margin it involves the removal of large areas of facial skin, but there is a tendency for facial surgery to remove as little tissue as possible and the edges of the tumors are not well resected, this increases the risk of recurrence being more aggressive and infiltrative, greater tissue destruction, added the risk of suffering several BCC after the appearance of the first one, so it requires different surgeries and this can deform, mutilate organs or give rise to extensive scars, also the reconstruction of the affected area can cause aesthetic-functional alterations. ^6,7

Therefore, the importance of conservative treatment of BCC in the facial region. There is a group of patients in whom surgery is not possible because of the characteristics of the tumor, its size or location, they can be deforming or disfiguring and even mutilating organs in the facial region, the patient does not tolerate (age, comorbidities, medications, allergy to anesthetics) or refuses surgery because it is not desirable. ⁸

Among the non-surgical therapies are vismodegib and sonidegib used in advanced and metastatic BCC. Research has shown maintenance or slight impairment life quality in relation to surgical techniques, but significantly due to adverse events generated by these drugs (muscle spasms, alopecia, dysgeusia, weight loss, asthenia, hyporexia, ageusia, diarrhea, nausea, fatigue and death); its high frequency of occurrence in patients leads to abandonment therapy, as well as high costs and long-term treatment regimens. ^9,10

Another non-surgical treatment option is the use of perilesional interferon, which is part of the intralesional chemotherapy used in the BCC treatment. The safety, efficacy and advantages of interferon treatment in BCC have been shown to be comparable with other methods, with excellent cosmetic outcomes and positive impact on life quality. ¹¹

HeberFERON is a mixture of alpha-2b and gamma interferons, with antiproliferative, antiangiogenic and immunomodulatory properties. The antitumor action of interferons occurs by inhibition of tumor cell growth and induction of tumor cell apoptosis (programmed cell death). The independent effect of interferons can be potentiated with the combination of both based on their synergistic antiproliferative effect and other properties. HeberFERON is a therapeutic option that decreases tumor size or complete tumor removal, thus reducing the need for mutilation of skin sections or deformities in places like the face, which means a better life quality is indicated in any clinical, histological subtype, location or size, especially in tumors occurring in difficult areas, when surgery could be disfiguring or in patients who cannot undergo this procedure due to some disease and in high-risk BCC, which are special locations that show a higher rate of tumor recurrence and possibility of invasion to adjacent and underlying structures such as the periocular, nose, nasolabial fold, preauricular, retroauricular fold, auricular pavilion and scalp. ¹²

HeberFERON being a mixture of two interferons produces an increase and prolongation of pharmacological activity without additional toxicity, with a more rapid and prolonged effect compared to individual interferons, decreased frequency of injections, excellent cosmetic results, compared to surgery and associated reconstructive procedures, along with increased patient compliance and HRQoL. ^12,13

There are few publications on this subject, however, there are recent investigations conducted in Cuba in patients with BCC treated with HeberFERON that indirectly demonstrate the positive influence of this product on the patient's life quality. ^12,13

Likely, for the adverse events caused by HeberFERON, they are characterized by being grade I - II, given by a pseudo-flu syndrome (fever, headache, chills, myalgia, asthenia, arthralgia, and general malaise), these manifestations are frequent, transitory, dose-dependent, reversible when the treatment is stopped and can be reduced with non-steroidal anti-inflammatory drugs. ^14,15

Life quality is essential in the evaluation of treatment outcomes as part of comprehensive patient care and important in the assessment of the results of the different types of BCC treatment also for clinical and care studies however, it is not routinely used and should be investigated before, at the end of treatment and months after its conclusion. ¹⁶

Some researchers do not take into account HRQoL, a significant aspect when evaluating therapy in a patient with BCC, however, if it is evaluated in a comprehensive way and not only removing the tumor, which is the priority in medical care, it becomes extremely important. In Cuba, the incidence of skin cancer increases every year with the diagnosis of new cases mainly due to BCC. How would the patient's face be after the procedure to eliminate the neoplasm? How does he/she face the new measures to avoid new tumors? How does the society where he/she develops value him/her, when faced with a mutilation, disfigurement or scar in the facial region? These are questions that make us think about how life quality will be in the patient with skin cancer. HeberFERON is a treatment modality that confirms new horizons in BCC. Cuban articles show HRQoL studies in several skin diseases, but not in non-melanoma skin cancer, specifically in BCC, so research is needed to study this important issue for both, the patient and the health professional.

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Received: January 26, 2022; Accepted: March 08, 2022

^*Autor para la correspondencia. Correo electrónico: [e-mail]

No existe conflicto de interés en esta investigación.