What to know about chemotherapy cream

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Chemotherapy cream is a topical ointment or cream that a person applies to the skin.

Doctors commonly prescribe a drug called 5-fluorouracil (5FU). It works by killing fast growing skin cells, including cancer cells and cells that are dividing so quickly that they may become cancer.

Some brand names for fluorouracil cream include:

• Efudex
• Fluoroplex
• Carac
• Tolak

Topical chemotherapy penetrates the outer layers of the skin. Doctors usually prescribe it to treat precancerous conditions, such as actinic keratosis. A person may also use topical chemotherapy for early stage basal and squamous cell skin cancers.

Topical chemotherapy’s main uses include the following:

• Preventing skin cancer: Certain conditions, such as actinic keratosis, may become cancerous. Doctors sometimes prescribe ointment as an alternative to surgery to prevent cancer. They may also suggest chemotherapy cream to treat large areas of sun-damaged skin with many precancers.
• Treating skin cancer: Some superficial forms of squamous cell and basal cell carcinoma may respond to chemotherapy cream.
• Treating skin manifestations of other cancers: Some cancers that most people do not think of as skin cancer can affect the skin. For example, T cell lymphoma can cause mycosis fungoides on the skin. An older 2013 study concluded that topical chemotherapy is a safe and effective treatment option for mycosis fungoides.
• Treating certain eye cancers: Certain cancers of the eye affect the skin of the eye. A doctor may recommend chemotherapy eye drops or creams for cancers such as giant ocular surface squamous neoplasia.

For skin cancer

Chemotherapy cream primarily treats cancers that affect the skin. A doctor may prescribe the cream to prevent certain lesions from becoming cancerous. The cream can also treat superficial types of skin cancer.

In some cases, a doctor may recommend using chemotherapy cream along with other treatments, such as surgery, to cure cancer and prevent it from coming back.

In people who are too sick to undergo surgery or who wish to avoid surgery, chemotherapy cream may be an alternative.

Learn more about skin cancer here.

Topical chemotherapy may be an effective treatment option for certain cancers. The list below looks at what the research currently suggests.

• A 2018 study involving 10 people with giant ocular surface squamous neoplasia, which is a type of skin cancer in the eye, assessed whether or not people needed surgery after using chemotherapy cream. All the participants’ tumors shrank.
• A 2013 review looked at the use of chemotherapy cream to treat nonmelanoma skin cancers. With imiquimod, cure rates were 65–100%. Cure rates with 5FU cream were 61–92%. Keratoacanthoma, which is a type of squamous cell carcinoma, had the highest cure rate with chemotherapy cream. Methotrexate cured 91% of cancers, compared with a higher cure rate of 98% for 5FU cream.
• A 2019 study suggested that chemotherapy cream, when a person uses it with other treatments, can reduce the risk of developing skin cancer. For example, doctors may prescribe 5FU cream to people with actinic keratosis, which is a type of sun-related skin damage that can lead to skin cancer.

Type of cancer may determine type of cream

The specific benefits of chemotherapy cream to prevent cancer depend on the type of cancer a doctor wants to prevent.

For example, a 2018 randomized clinical trial found a 75% reduction in the risk of developing squamous cell carcinoma in the first year following treatment with chemotherapy cream.

Although there was a slight reduction in the risk of basal cell carcinoma, the reduction was not statistically significant. Chemotherapy cream did not reduce the risk of keratinocyte carcinomas, but surgery did.

There is limited research suggesting that certain types of chemotherapy cream may help skin manifestations of other cancers.

For example, a 2013 study tested mechlorethamine cream in people with T cell lymphoma who had mycosis fungoides, which is a skin manifestation of lymphoma. The study compared a gel with a compounded ointment. The gel shrunk the participants’ tumors by 58.5%, and the ointment shrunk them by 47.7%.

The most common side effects occur at the site where the person applies the cream. They include:

• pain, itching, or burning
• flushing
• loss of skin
• crusty skin
• dry skin

Some people may notice flu-like symptoms. A person might also experience eye pain, itching, or blurry vision, especially if they get cream in or near the eye.

People who do not have enough of the enzyme dihydropyrimidine dehydrogenase in their bodies are more likely to experience side effects such as nausea and vomiting.

Chemotherapy cream can be a treatment that a person uses alongside other interventions. It can also be a stand-alone treatment.

Alternatives depend on the type of cancer a person has, their overall health, and how they feel about side effects. Some alternative treatments include:

• surgery to remove skin cancer or precancerous cells
• immunotherapy, which is a type of treatment that trains the body’s immune system to fight cancer
• targeted medications that kill specific cancer cells
• chemotherapy
• radiation therapy
• photodynamic therapy, which uses light to kill cancer or precancerous cells
• drugs such as retinoids
• chemical peels for actinic keratosis

Chemotherapy cream can be a good option for some cancers, but it does not treat all cancers or even all skin cancers. It can also cause serious side effects. It is important to discuss the risks, benefits, and limitations of treatment with a doctor before proceeding.

A dermatologist can help a person consider their treatment options. People should be sure to discuss treatment goals, potential outcomes, and possible side effects.