Optimal combination with PUVA: rationale and clinical trial update.
Cutaneous T-cell lymphoma (CTCL) is relatively benign in its early stages, but survival rates decrease dramatically as the disease progresses. As no curative therapies are currently available, the goal of therapy is preventing or delaying progression from early disease stages while minimizing long-term toxicity. No single agent, including psoralen plus ultraviolet A (PUVA), can control disease progression fully, so combination therapy is needed to improve response rates. In addition, low-dose combination therapy may improve treatment safety and tolerability. A combination of PUVA and interferon (IFN) alpha in early disease has been shown to be effective and well tolerated. Likewise, small studies of PUVA and bexarotene (Targretin) indicate good efficacy for this combination. Reduced doses of these combinations may also be effective as maintenance therapies following complete remission. Other treatment combinations shown to be effective in early disease stages include bexarotene with IFNalpha and bexarotene with denileukin diftitox (Ontak). In advanced stages of CTCL, liposomal-encapsulated doxorubicin or extracorporeal photopheresis may be combined with bexarotene or IFNalpha.
Stadler
Rudolf
R
Department of Dermatology, Medical Centre Minden, Germany. hautklinik@klinikum-minden.de
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000077610:Bexarotene; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D004167:Diphtheria Toxin / Q000627:therapeutic use; D018450:Disease Progression; D004317:Doxorubicin / Q000627:therapeutic use; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D016898:Interferon-alpha / Q000627:therapeutic use; D007376:Interleukin-2 / Q000627:therapeutic use; D016410:Lymphoma, T-Cell, Cutaneous / Q000188:drug therapy* / Q000473:pathology; D009367:Neoplasm Staging; D011701:PUVA Therapy; D017893:Photopheresis; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D012176:Retinoids / Q000627:therapeutic use; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology; D013764:Tetrahydronaphthalenes / Q000627:therapeutic use
D000970:Antineoplastic Agents; D004167:Diphtheria Toxin; D007155:Immunologic Factors; D016898:Interferon-alpha; D007376:Interleukin-2; D011993:Recombinant Fusion Proteins; D012176:Retinoids; D013764:Tetrahydronaphthalenes; C078456:denileukin diftitox; D004317:Doxorubicin; D000077610:Bexarotene