title: Low-dose electron beam radiation and romidepsin therapy for symptomatic cutaneous T-cell lymphoma lesions.
abstract: BACKGROUND
  Romidepsin is a structurally unique histone deacetylase inhibitor approved by the U.S. Food and Drug Administration for therapy of relapsed or refractory cutaneous T-cell lymphoma (CTCL). Localized electron beam radiation therapy (LEBT) is standard practice in the care of patients with chronically traumatized and painful lesions. Combination therapy of those two modalities may be beneficial for the therapy of CTCL.
  
  
  OBJECTIVE
  To report observations on supportive LEBT utilized for isolated refractory lesions in patients on romidepsin.
  
  
  METHODS
  Observations were made during a phase II clinical trial sponsored by the National Cancer Institute (NCI-1312) examining the efficacy of romidepsin for patients with relapsed, refractory or advanced CTCL, stage IB-IVA mycosis fungoides (MF) or Sézary syndrome. Skin responses were assessed by evaluation of five target lesions only. Patients with objective clinical responses in target lesions who had symptomatic nontarget lesions were allowed limited LEBT to isolated lesions for symptomatic relief. Patients who received localized radiation were not considered complete responders at any point.
  
  
  RESULTS
  Five patients with advanced MF (three stage IIB and two stage IVA2) received LEBT to symptomatic nontarget lesions while on a protocol with romidepsin. None of these patients experienced additional or unexpected toxicity. Four of the five patients demonstrated fast and durable responses. We noted that significantly lower than standard doses of LEBT effectively treated symptomatic lesions in these patients.
  
  
  CONCLUSIONS
  LEBT demonstrated significant responses at very low doses without additional toxicity in patients on protocol treatment with the histone deacetylase inhibitor romidepsin. This merits formal investigation in a clinical trial for potential synergy in patients with CTCL.
authors.affiliation: Department of Dermatology, University of Pittsburgh, 200 Lothrop Street, Presby South Tower, Suite 3880, Pittsburgh, PA 15213, USA.
authors.forename: O E
authors.initials: OE
authors.lastname: Akilov
authors.forename: C
authors.initials: C
authors.lastname: Grant
authors.forename: R
authors.initials: R
authors.lastname: Frye
authors.forename: S
authors.initials: S
authors.lastname: Bates
authors.forename: R
authors.initials: R
authors.lastname: Piekarz
authors.forename: L J
authors.initials: LJ
authors.lastname: Geskin
mesh_terms: D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D047630:Depsipeptides / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016410:Lymphoma, T-Cell, Cutaneous / Q000188:drug therapy* / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D012878:Skin Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*
chemical_list: D000903:Antibiotics, Antineoplastic; D047630:Depsipeptides; C087123:romidepsin