Pegasys for Cutaneous T-cell lymphomas (CTCL) and Mycosis Fungoides – pro

Cutaneous T-cell lymphoma (CTCL) is classified as an indolent hematologic malignancy with distinct clinicopathologic features. Mycosis Fungoides is a subset of CTCL. Although prognosis varies depending on the stage, patients who have cutaneous tumors, lymph node or visceral involvement, or peripheral blood involvement (Sézary syndrome) generally have a poor outcome.
For advanced disease, systemic treatment options include low-dose methotrexate, photopheresis, biologic response modifiers such as bexarotene capsules, vorinostat (Zolinza), interferons, denileukin diftitox (Ontak), and single-agent chemotherapy. Combination therapies can be used when single agents fail or when patients have advanced or progressive disease.

Interferon is a valuable agent in the armamentarium; alfa interferon (IFN)as a single agent has shown partial remission rates of > 50% and complete responses of > 20%. Pegasys is a pegylated and pharmacologically dsitinct type of interferon. It has not been extensively studied for cutaneous lymphoma, although the first report already appeared in 1993. Most studies have been retrospective and/or were in combination with other drugs or therapies. In a recent retrospective cohort study reported in 2011 in Journal of the European Academy of Dermatology and Venereology: PEG-Interferon Alfa-2b and Ultraviolet Light Therapy in Treating Patients With Stage IB, Stage II, Stage III, or Stage IVA Mycosis Fungoides/Sezary Syndrome, NCT00724061, myelosuppression and liver toxicity occured more frequently during PEG-IFN α-2b plus PUVA treatment than during standard IFN α-2a plus PUVA therapy [77.8 vs. 50% (odds ratio 1.477) and 77.8 vs. 50% (odds ratio 1.692), respectively]. The overall response rate in the PEG-IFN α-2b plus PUVA group (89%) was significantly superior.

Several other similar studies showed comparable results. However, there are no randomized controlled studies against other treatments than interferon and no guideline recommendations.

Taku Fujimura, Ryuhei Okuyama, Akira Hashimoto, Hiroshi Watanabe, Satoshi Nakagawa, Hachiro Tagami, Setsuya Aiba Effective Control of Rush Progression of CD8+ Mycosis Fungoides with Pegylated Interferon, Acta Derm Venereol. 2006;86(2):161-2.

S.J.WHITTAKER et al, Joint British Association of Dermatologists and U.K. Lymphoma Group guidelines for the management of primary
cutaneous T-cell lymphomas. Cutaneous British Journal of Dermatology 2003; 149: 1095–1107.

Hüsken AC, Tsianakas A, Hensen P, Nashan D, Loquai C, Beissert S, Luger TA, Sunderkötter C, Schiller M.
Comparison of pegylated interferon α-2b plus psoralen PUVA versus standard interferon α-2a plus PUVA in patients with cutaneous T-cell lymphoma.J Eur Acad Dermatol Venereol. 2012 Jan;26(1):71-8.

Dummer, Reinhard Emerging drugs in cutaneous T-cell lymphomas
Expert Opinion on Emerging Drugs, Volume 10, Number 2, 1 May 2005 , pp. 381-392(12)

Y. Oyama, J. Guitart, T. Kuzel, R. Burt, S. RosenHigh-dose therapy and bone marrow transplantation in cutaneous T-cell lymphoma.
Hematology/Oncology Clinics of North America, Volume 17, Issue 6, Pages 1475-1483, 2003.
Whittaker SJ, Marsden JR, Spittle M, Russell Jones R. Joint British Association of Dermatologists and U.K. Cutaneous Lymphoma Group guidelines for the management of primary cutaneous T-cell lymphomas. Br J Dermatol 2003 Dec;149(6):1095-107. [67 references

Elise A. Olsen Interferon in the treatment of cutaneous T-cell lymphoma
Dermatologic Therapy Volume 16 Issue 4, Pages 311 – 321

Ghadah I. AL Hothal, Review of the treatment of mycosis fungoides and Sézary syndrome: A stage-based approachInt J Health Sci (Qassim). 2013 Jun; 7(2): 220–239..

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