Temozolomide for central nervous system involvement in mycosis fungoides.
BACKGROUND
The central nervous system (CNS) is one of the most commonly involved sites in the systemic progression of primary cutaneous T cell lymphomas (CTCLs) such as mycosis fungoides (MF). There is no consensus on the treatment of CNS progression in CTCL, but survival of 3-6 months is suggested when methotrexate-based chemotherapy and/or CNS irradiation is used. Temozolomide is active in earlier stages of MF and readily crosses the blood-brain barrier. There are no published data on its use in MF patients with CNS involvement.


METHODS
Four MF patients were treated with oral temozolomide (200 mg/m(2) per day for 5 d on a 28-day cycle) for CNS progression. Two patients received temozolomide with low-dose CNS irradiation as initial treatment, and two received temozolomide following disease progression after methotrexate-based chemotherapy and CNS irradiation. All patients received dexamethasone.


RESULTS
Temozolomide was well tolerated; there were no treatment withdrawals or dose reductions caused by toxicity. Patient 1 had an excellent partial response in pre-irradiated disease. Patient 2 showed disease stabilization following irradiation. Patient 3 showed a complete response after a partial response to irradiation. Patient 4 demonstrated continued stabilization after a partial response to irradiation. Overall survival ranged from 10 to 33 months. Patient 3 remains alive and symptom-free at 23 months following treatment.


CONCLUSIONS
Temozolomide following low-dose CNS irradiation appears to be well tolerated and effective in MF patients with CNS progression. It may represent a less toxic alternative to chemotherapy containing methotrexate or an option for second-line therapy.
Department of Clinical Oncology, Guy's and St Thomas' National Health Service Foundation Trust, London, UK.
Thomas G
TG
Bird
Department of Dermatology, Guy's and St Thomas' National Health Service Foundation Trust, London, UK.
Sean
S
Whittaker
Department of Dermatology, Guy's and St Thomas' National Health Service Foundation Trust, London, UK.
Elizabeth M
EM
Wain
Department of Dermatology, Guy's and St Thomas' National Health Service Foundation Trust, London, UK.
Fiona
F
Child
Department of Clinical Oncology, Guy's and St Thomas' National Health Service Foundation Trust, London, UK.
Stephen L
SL
Morris
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002493:Central Nervous System Diseases / Q000188:drug therapy* / Q000209:etiology / Q000532:radiotherapy; D003606:Dacarbazine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D009182:Mycosis Fungoides / Q000150:complications / Q000188:drug therapy*; D019233:Retreatment; D012878:Skin Neoplasms / Q000150:complications / Q000188:drug therapy*; D000077204:Temozolomide; D016896:Treatment Outcome
D003606:Dacarbazine; D003907:Dexamethasone; D000077204:Temozolomide; D008727:Methotrexate