title: Lack of durable disease control with chemotherapy for mycosis fungoides and Sézary syndrome: a comparative study of systemic therapy.
abstract: Numerous systemic treatment options exist for patients with mycosis fungoides (MF) and Sézary syndrome (SS), but no large comparative studies are published. To study the efficacy of treatments, a retrospective analysis of our cutaneous lymphoma database was undertaken, with 198 MF/SS patients undergoing systemic therapies. The primary end point was time to next treatment (TTNT). Patients with advanced-stage disease made up 53%. The median follow-up time from diagnosis for all alive patients was 4.9 years (range 0.3-39.6), with a median survival of 11.4 years. Patients received a median of 3 lines of therapy (range 1-13), resulting in 709 treatment episodes. Twenty-eight treatment modalities were analyzed. The median TTNT for single- or multiagent chemotherapy was only 3.9 months (95% confidence interval [CI] 3.2-5.1), with few durable remissions. α-interferon gave a median TTNT of 8.7 months (95% CI 6.0-18.0), and histone deacetylase inhibitors (HDACi) gave a median TTNT of 4.5 months (95% CI 4.0-6.1). When compared directly with chemotherapy, interferon and HDACi both had greater TTNT (P < .00001 and P = .01, respectively). This study confirms that all chemotherapy regimens assessed have very modest efficacy; we recommend their use be restricted until other options are exhausted.
authors.affiliation: Division of Haematology and Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia;
authors.forename: Charlotte F M
authors.initials: CF
authors.lastname: Hughes
authors.affiliation: Division of Haematology and Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia;
authors.forename: Amit
authors.initials: A
authors.lastname: Khot
authors.affiliation: Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia; Department of Dermatology, St. Vincent's Hospital Department of Medicine, Melbourne, Australia;
authors.forename: Christopher
authors.initials: C
authors.lastname: McCormack
authors.affiliation: Division of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia; and.
authors.forename: Stephen
authors.initials: S
authors.lastname: Lade
authors.affiliation: Division of Haematology and Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia; Division of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia; and.
authors.forename: David A
authors.initials: DA
authors.lastname: Westerman
authors.affiliation: Division of Haematology and Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia;
authors.forename: Robert
authors.initials: R
authors.lastname: Twigger
authors.affiliation: Division of Haematology and Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia;
authors.forename: Odette
authors.initials: O
authors.lastname: Buelens
authors.affiliation: Division of Haematology and Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia;
authors.forename: Kate
authors.initials: K
authors.lastname: Newland
authors.affiliation: Division of Haematology and Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia;
authors.forename: Constantine
authors.initials: C
authors.lastname: Tam
authors.affiliation: Division of Haematology and Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia;
authors.forename: Michael
authors.initials: M
authors.lastname: Dickinson
authors.affiliation: Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Gail
authors.initials: G
authors.lastname: Ryan
authors.affiliation: Division of Haematology and Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia;
authors.forename: David
authors.initials: D
authors.lastname: Ritchie
authors.affiliation: Division of Haematology and Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia;
authors.forename: Colin
authors.initials: C
authors.lastname: Wood
authors.affiliation: Division of Haematology and Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia;
authors.forename: H Miles
authors.initials: HM
authors.lastname: Prince
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001706:Biopsy; D003131:Combined Modality Therapy; D004358:Drug Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D056572:Histone Deacetylase Inhibitors / Q000627:therapeutic use; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009182:Mycosis Fungoides / Q000188:drug therapy*; D012074:Remission Induction; D012189:Retrospective Studies; D012751:Sezary Syndrome / Q000188:drug therapy*; D012878:Skin Neoplasms / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D056572:Histone Deacetylase Inhibitors; D016898:Interferon-alpha