Generic Name

Xadago

Mechanism

• Src‑family kinase inhibition – tirbanibulin binds to the ATP‑binding pocket of Src kinases, blocking their phosphorylation activity and downstream signaling (MAPK & PI3K/Akt pathways).
• Microtubule destabilization – concurrently, it binds to microtubules, impairing mitotic spindle formation and inducing apoptosis in rapidly dividing keratinocytes.
• Result – selective cytotoxicity of AK lesions without significant systemic absorption.

Pharmacokinetics

Indications

• Actinic keratosis of the face and scalp.
• Only for superficial (non‑infiltrating) AK lesions.

Contraindications

• Hypersensitivity to tirbanibulin or any gel components.
• Inflamed, broken, or ulcerated skin – avoid application.
• Ocular surface – protect eyes; use ophthalmic barrier before and after dosing.
• Pregnancy – not recommended; no definitive safety data.
• Lactation – data insufficient; risk vs. benefit must be considered.

Dosing

• Dosage form: 1 % (0.1 %) gel (1 mL) in a soft, pliable container.
• Application: Apply 0.5 mL (approx. 1 g) to all AK lesions and surrounding skin.
• Frequency: Once daily for 5 consecutive days (days 1‑5).
• Technique:
• Cleanse skin with mild soap; pat dry.
• Apply thin, even film; avoid excessive rubbing.
• Cover with non‑occlusive dressing if needed.

Adverse Effects

Common (≥ 5 %)
• Local irritation (erythema, itching, burning)
• Erythema ab igne or mild edema
• Dryness / scaling
• Mild pruritus

Serious (≤ 1 %)
• Severe dermatitis or contact dermatitis (rare)
• Allergic reaction (rash, angioedema)

Rare / Notable
• No systemic toxicity observed.

Monitoring

• Clinical assessment: Evaluate lesion resolution 2–4 weeks post‑treatment.
• Skin integrity: Look for non‑specific irritation; discontinue if severe.
• Patient education: Counsel on strict photoprotection during and after therapy.

Clinical Pearls

• 5‑day regimen – *Xadago*’s short course reduces patient burden versus 4‑week daily schedules of other AK agents.
• Comprehensive coverage – Apply to all lesions in the field to reduce recurrence risk.
• Sun protection – Advise sunscreen (SPF ≥ 30) immediately after application; UV exposure can negate benefits.
• Application near ocular area – Use protective barriers; ocular irritation can mimic allergic conjunctivitis.
• Combination therapy – Adjunctive cryotherapy or photodynamic therapy can lower recurrence, but data are limited.

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• Key Takeaway

Tirbanibulin (Xadago) offers a well‑tolerated, short‑duration topical option for superficial actinic keratosis, leveraging dual Src‑kinase inhibition and microtubule destabilization for targeted lesion clearance.