Ingenol mebutate (ingenol 3-angelate, PEP005): Focus on its uses in the treatment of nonmelanoma skin cancer

It is estimated that there are 2 million new cases of nonmelanoma skin cancer (NMSC) in the USA annually. Current treatment modalities pose significant morbidity, which can consequently lead to unfavorable cosmetic outcomes. This in turn leads to the direct and indirect management costs of treating NMSC approaching billions of dollars annually. There have been anecdotal reports of Euphorbia peplus sap use as a successful home remedy for skin malignancies, which suggest it may be an effective topical treatment for NMSC. Further investigations have isolated one among the many active ingredients found in E. peplus sap, ingenol mebutate (PEP005). Research studies have revealed that ingenol mebutate has both a direct cytotoxic effect and a local moderate acute inflammatory response in mediating its anticancer effects. In addition to its high efficacy in the treatment of NMSC, clinical studies have reported ingenol mebutate to have minor application site side effects that resolved shortly after stopping treatment, little morbidity, favorable cosmetic outcomes and no detectable systemic exposure. © 2012 Expert Reviews Ltd.