MBS call for topical brachytherapy for non-melanoma skin cancer

Brachytherapy paste rhenium-188 is painless, anaesthetic-free and up for consideration at MSAC in July.

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Sponsors of Rhenium-SCT, a topical brachytherapy to treat non-melanoma skin cancer lesions, have applied to the Medical Services Advisory Committee for listing of the treatment.

Currently costing between $7000 and $8000 for a single treatment, Rhenium-SCT is only offered by private clinic Avion Medical in Melbourne, however GenesisCare will soon begin providing it through their Queensland and New South Wales clinics.

During treatment, the affected area of the skin is covered with the sterile protective foil. The rhenium-188 paste is then applied in a matrix on the foil using a special applicator device. After the calculated irradiation time, the matrix is removed by pulling the foil from the skin.

“It’s a non-invasive, painless procedure that is suitable as an alternative when radiation therapy may not be possible or is refused by the patient,” said Dr Sam Vohra, medical director of Avion Medical, speaking at the Australasian Skin Cancer Congress on the Gold Coast last weekend.

No anaesthetic is required for the procedure.

Because the paste conforms to the contours of the skin, rhenium-SCT is particularly suited to difficult to reach lesions, such as inside the ears. There is also potential for using rhenium-SCT to shrink larger lesions, making them more amenable for later surgery.

Healing occurs over a period of six to eight weeks, with follow-up again at 12 weeks, depending on the individual patient’s inflammation response.

Dr Vohra said interim results from the EPIC-Skin trial appeared to confirm earlier findings about the treatment’s efficacy and safety. Those trials reported cure rates after 12 months of over 90% with very few adverse events. Dr Vohra said the EPIC interim results were showing improvements in quality of life overall, as well as emotional, social and physical appearance subscales.

“One hundred percent of patients reported no pain or discomfort during the treatment,” she told the ASCC.

“We are pleased to report that at the six-month mark 103 of 106 patients (97.2%) of the patients reported a complete response. This is really confirmatory evidence of the data that we’ve seen in the past. There have been no adverse events.”

Rhenium-SCT was approved by the TGA and placed on the Australian Register of Therapeutic Goods on 9 December 2020.

Australian sponsor OncoBeta Therapeutics have applied for three new MBS item numbers for Rhenium-SCT.

“Rhenium-188 brachytherapy would represent a novel addition to the existing suite of options available in this setting, most suitable for a small subset of patients with difficult to treat lesions, uptake of which is expected to be limited by local experience and availability of necessary capital equipment,” said the company’s MSAC application.

The treatment would be delivered by “nuclear medicine physicians in collaboration with dermatologists, radiologists and/or plastic surgeons”, working in accredited nuclear medicine facilities in specialist public and private hospitals, with referral limited to specialist dermatologists or plastic surgeons.