Low-dose total skin electron beam therapy plus oral bexarotene maintenance therapy for cutaneous T-cell lymphoma.
Journal
Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG
ISSN: 1610-0387
Titre abrégé: J Dtsch Dermatol Ges
Pays: Germany
ID NLM: 101164708
Informations de publication
Date de publication:
Mar 2022
Mar 2022
Historique:
received:
11
06
2021
accepted:
13
09
2021
pubmed:
6
1
2022
medline:
23
3
2022
entrez:
5
1
2022
Statut:
ppublish
Résumé
Total skin electron beam therapy (TSEBT) combined with systemic therapy or maintenance treatment is a reasonable approach to enhance the remission rate and duration in mycosis fungoides (MF) and Sézary syndrome (SS). This study assesses the efficacy of oral bexarotene therapy after low-dose TSEBT for patients with MF and SS. In this prospective observational study, we recruited MF/SS patients for treatment with low-dose total skin electron beam therapy (TSEBT) with or without bexarotene therapy to describe outcomes and toxicities. Forty-six subjects with MF or SS underwent TSEBT between 2016 and 2021 at our institute. Following TSEBT, 27 patients (59 %) received oral bexarotene treatment. The median follow-up was 13 months. The overall response rate (ORR) for the cohort was 85 %. The response rate was significantly higher with combined modality (CM) than TSEBT alone (96 % vs. 68 %, p = 0.03). Median progression-free survival (PFS) for the CM was 17 months versus five months following TSEBT alone (p = 0.001). One patient (4 %) in the retinoid group discontinued the bexarotene therapy because of adverse events. The administration of bexarotene therapy did not increase radiation-related toxicities. Response rate and progression-free survival might be improved with TSEBT in combination with oral bexarotene compared to TSEBT alone.
Sections du résumé
BACKGROUND
BACKGROUND
Total skin electron beam therapy (TSEBT) combined with systemic therapy or maintenance treatment is a reasonable approach to enhance the remission rate and duration in mycosis fungoides (MF) and Sézary syndrome (SS). This study assesses the efficacy of oral bexarotene therapy after low-dose TSEBT for patients with MF and SS.
METHODS
METHODS
In this prospective observational study, we recruited MF/SS patients for treatment with low-dose total skin electron beam therapy (TSEBT) with or without bexarotene therapy to describe outcomes and toxicities.
RESULTS
RESULTS
Forty-six subjects with MF or SS underwent TSEBT between 2016 and 2021 at our institute. Following TSEBT, 27 patients (59 %) received oral bexarotene treatment. The median follow-up was 13 months. The overall response rate (ORR) for the cohort was 85 %. The response rate was significantly higher with combined modality (CM) than TSEBT alone (96 % vs. 68 %, p = 0.03). Median progression-free survival (PFS) for the CM was 17 months versus five months following TSEBT alone (p = 0.001). One patient (4 %) in the retinoid group discontinued the bexarotene therapy because of adverse events. The administration of bexarotene therapy did not increase radiation-related toxicities.
CONCLUSIONS
CONCLUSIONS
Response rate and progression-free survival might be improved with TSEBT in combination with oral bexarotene compared to TSEBT alone.
Substances chimiques
Bexarotene
A61RXM4375
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
279-285Informations de copyright
© 2022 The Authors. Journal der Deutschen Dermatologischen Gesellschaft published by John Wiley & Sons Ltd on behalf of Deutsche Dermatologische Gesellschaft.
Références
Elsayad K, Susek KH, Eich HT. Total skin electron beam therapy as part of multimodal treatment strategies for primary cutaneous T-cell lymphoma. Oncol Res Treat 2017; 40: 244-52.
Nawar T, Elsayad K, Müller EC et al. Quality of life in mycosis fungoides and Sézary-syndrome patients undergoing low-dose total skin electron beam therapy with or without maintenance therapy. J Am Acad Dermatol 2021 Mar 17; S0190-9622(21)00564-8 [Online ahead of print].
Hoppe RT, Harrison C, Tavallaee M et al. Low-dose total skin electron beam therapy as an effective modality to reduce disease burden in patients with mycosis fungoides: results of a pooled analysis from 3 phase-II clinical trials. J Am Acad Dermatol 2015; 72: 286-92.
Kamstrup MR, Gniadecki R, Iversen L et al. Low-dose (10-Gy) total skin electron beam therapy for cutaneous T-cell lymphoma: an open clinical study and pooled data analysis. Int J Radiat Oncol Biol Phys 2015; 92: 138-43.
Elsayad K, Kriz J, Moustakis C et al. Total skin electron beam for primary cutaneous T-cell lymphoma. Int J Radiat Oncol Biol Phys 2015; 93: 1077-86.
Morris S, Scarisbrick J, Frew J et al. the results of low-dose total skin electron beam radiation therapy (TSEB) in patients with mycosis fungoides from the UK Cutaneous Lymphoma Group. Int J Radiat Oncol Biol Phys 2017; 99: 627-33.
Klein RS, Dunlop JD, Samimi SS et al. Improvement in peripheral blood disease burden in patients with Sézary syndrome and leukemic mycosis fungoides after total skin electron beam therapy. J Am Acad Dermatol 2013; 68: 972-7.
Durgin JS, Jariwala NN, Wysocka M et al. Low-dose total skin electron beam therapy as part of a multimodality regimen for treatment of Sézary syndrome: clinical, immunologic, and molecular analysis. JAMA Dermatol 2021; 157(1): 90-5.
Stadler R, Scarisbrick JJ. Maintenance therapy in patients with mycosis fungoides or Sézary syndrome: A neglected topic. Eur J Cancer 2020; 142: 38-47.
Talpur R, Ward S, Apisarnthanarax N et al. Optimizing bexarotene therapy for cutaneous T-cell lymphoma. J Am Acad Dermatol 2002; 47: 672-84.
Abbott RA, Whittaker SJ, Morris SL et al. Bexarotene therapy for mycosis fungoides and Sézary syndrome. Br J Dermatol 2009; 160: 1299-307.
Nikolaou V, Patsatsi A, Sidiropoulou P et al. Monotherapy and combination therapy with acitretin for mycosis fungoides: results of a retrospective, multicentre study. J Eur Acad Dermatol Venereol 2020; 34(11): 2534-40.
Simontacchi G, Lo Russo M, Marrazzo L et al. PO-0735: Low dose total skin irradiation followed by maintenance with oral bexarotene in mycosis fungoides. Radiother Oncol 2018; 127: S376.
Jones G, McLean J, Rosenthal D et al. Combined treatment with oral etretinate and electron beam therapy in patients with cutaneous T-cell lymphoma (mycosis fungoides and Sézary syndrome). J Am Acad Dermatol 1992; 26: 960-7.
Simontacchi G, Lo Russo M, Marrazzo L et al. Low dose total skin irradiation followed by maintenance with oral bexarotene in mycosis fungoides. Radiother Oncol 2018; 127: S376.
Pileri A, Fava P, Fuligni F et al. Bexarotene as maintenance treatment after therapies other than skin-directed therapy in advanced-stage mycosis fungoides: a pilot study. J Eur Acad Dermatol Venereol 2019; 33: e367-e369.
Olsen EA, Whittaker S, Kim YH et al. Clinical end points and response criteria in mycosis fungoides and Sézary syndrome: a consensus statement of the international society for cutaneous lymphomas, the United States Cutaneous Lymphoma Consortium, and the Cutaneous Lymphoma Task Force of the European Organisation for Research and Treatment of Cancer. J Clin Oncol 2011; 29: 2598-607.
Elsayad K, Moustakis C, Simonsen M et al. In-vivo dosimetric analysis in total skin electron beam therapy. Phys Imaging Radiat Oncol 2018; 6: 61-5.
Kroeger K, Elsayad K, Moustakis C et al. Low-dose total skin electron beam therapy for cutaneous lymphoma. Strahlenther Onkol 2017; 193: 1024-30.
Dalal M, Mitchell S, McCloskey C et al. The clinical and humanistic burden of cutaneous T-cell lymphomas and response to conventional and novel therapies: results of a systematic review. Expert Rev Hematol 2020; 13: 405-19.
Whittaker S, Hoppe R, Prince HM. How I treat mycosis fungoides and Sézary syndrome. Blood 2016; 127: 3142-53.
Duvic M, Lemak NA, Redman JR et al. Combined modality therapy for cutaneous T-cell lymphoma. J Am Acad Dermatol 1996; 34: 1022-9.
Trautinger F, Eder J, Assaf C et al. European Organisation for Research and Treatment of Cancer consensus recommendations for the treatment of mycosis fungoides/Sézary syndrome - Update 2017. Eur J Cancer 2017; 77: 57-74.
Cheeley J, Sahn RE, DeLong LK et al. Acitretin for the treatment of cutaneous T-cell lymphoma. J Am Acad Dermatol 2013; 68: 247-54.
Prince HM, Kim YH, Horwitz SM et al. Brentuximab vedotin or physician's choice in CD30-positive cutaneous T-cell lymphoma (ALCANZA): an international, open-label, randomised, phase 3, multicentre trial. The Lancet 2017; 390: 555-66.
Quirós PA, Jones GW, Kacinski BM et al. Total skin electron beam therapy followed by adjuvant psoralen/ultraviolet-A light in the management of patients with T1 and T2 cutaneous T-cell lymphoma (mycosis fungoides). Int J Radiat Oncol Biol Phys 1997; 38: 1027-35.
Kudelka MR, Switchenko JM, Lechowicz MJ et al. Maintenance therapy for cutaneous T-cell lymphoma after total skin electron irradiation: evidence for improved overall survival with ultraviolet therapy. Clin Lymphoma Myeloma Leuk 2020; 20: 757-767.e3.
Navi D, Riaz N, Levin YS et al. The Stanford University experience with conventional-dose, total skin electron-beam therapy in the treatment of generalized patch or plaque (T2) and tumor (T3) mycosis fungoides. Arch Dermatol 2011; 147: 561-7.
Lindahl LM, Kamstrup MR, Petersen PM et al. Total skin electron beam therapy for cutaneous T-cell lymphoma: a nationwide cohort study from Denmark. Acta Oncol 2011; 50: 1199-205.
Jennings T, Duffy R, Gochoco A et al. Valchlor maintenance therapy for patients with mycosis fungoides who received low dose total skin electron beam treatment. Chin Clin Oncol 2019; 8: 13.
Wilson LD, Licata AL, Braverman IM et al. Systemic chemotherapy and extracorporeal photochemotherapy for T3 and T4 cutaneous T-cell lymphoma patients who have achieved a complete response to total skin electron beam therapy. Int J Radiat Oncol Biol Phys 1995; 32: 987-95.
Lesokhin AM, Ansell SM, Armand P et al. Nivolumab in patients with relapsed or refractory hematologic malignancy: preliminary results of a phase Ib study. J Clin Oncol 2016; 34: 2698-704.
Khodadoust MS, Rook AH, Porcu P et al. Pembrolizumab in relapsed and refractory mycosis fungoides and Sézary syndrome: a multicenter phase II study. J Clin Oncol 2020; 38: 20-8.
Kim SJ, Lim JQ, Laurensia Y et al. Avelumab for the treatment of relapsed or refractory extranodal NK/T-cell lymphoma: an open-label phase 2 study. Blood 2020; 136(24): 2754-63.
Elsayad K, Stadler R, Steinbrink K et al. Combined total skin radiotherapy and immune checkpoint inhibitors: A promising potential treatment for mycosis fungoides and Sézary syndrome. J Dtsch Dermatol Ges 2020; 18: 193-7.
Fong S, Hong EK, Khodadoust MS et al. Low-dose total skin electron beam therapy combined with mogamulizumab for refractory mycosis fungoides and Sézary syndrome. Adv Radiat Oncol 2020; 6(3): 100629.
Song S, Holkova B, Mukhopadhyay N et al. Phase Ib study of brentuximab vedotin (BV) with low-dose total skin electron beam (LD-TSEB) for treatment of mycosis fungoides (MF) and Sézary syndrome (SS). J Clin Oncol 2020; 38: e20037.