Abstract | BACKGROUND:
Psoralen plus ultraviolet A (PUVA) is the standard treatment for early stages of mycosis fungoides. There have been no adequate randomized controlled trials with sufficient power comparing this modality with other therapies. OBJECTIVE: To assess disease response and to compare the response rates of patients treated with PUVA alone or PUVA and bexarotene. METHODS: EORTC 21011 (NCT 00056056) was a randomized phase III study comparing combined bexarotene ( Targretin(®) ) and PUVA vs. PUVA alone in patients with stage IB and IIA mycosis fungoides (MF). The primary endpoint was the overall response rate [complete clinical response (CCR) plus partial response (PR)]. RESULTS: The study was prematurely closed due to low accrual after 93 of 145 required patients (65%) were randomized. Of the 93 randomized patients, 87 started treatment, 41 received PUVA and 46 received PUVA + bexarotene. Total UVA doses received were 107 J cm(-2) (range 1·4-489·9) in the PUVA arm vs. 101·7 J cm(-2) (0·2-529·9) in the combination arm. The safety profile was acceptable with few grade 3-4 toxicities observed in either arm. More drop-outs due to toxicity were observed in the combination arm compared with the PUVA-alone arm. The best overall response (CCR + PR) rate was 71% for PUVA alone and 77% for the combination arm (P = 0·57). The median duration of response was 9·7 months for PUVA vs. 5·8 months for the combination arm (P = 0·33). CCR was seen in 25 patients of whom 10 received PUVA alone (CCR 22%) and 15 received combination therapy (CCR 31%) (P = 0·45). CCR was sustained in 25% of patients regardless of therapy. There was a trend towards fewer PUVA sessions needed to achieve CCR in the combination arm (median 22) compared with the PUVA arm (median 27·5) (P = 0·11). Similarly, a trend towards lower UVA dose required to achieve CCR in the combination arm (median 55·8 J cm(-2) ) compared with the PUVA arm alone (median 117·5 J cm(-2) ) (P = 0·5) was observed. CONCLUSIONS: No significant difference in response rate or response duration was observed in this study. However, there was a trend towards fewer PUVA sessions and lower UVA dose required to achieve CCR in the combination arm (PUVA + bexarotene) but this did not achieve statistical significance due to insufficient power.
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Authors | S Whittaker, P Ortiz, R Dummer, A Ranki, B Hasan, B Meulemans, S Gellrich, R Knobler, R Stadler, M Karrasch |
Journal | The British journal of dermatology
(Br J Dermatol)
Vol. 167
Issue 3
Pg. 678-87
(Sep 2012)
ISSN: 1365-2133 [Electronic] England |
PMID | 22924950
(Publication Type: Clinical Trial, Phase III, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Copyright | © 2012 The Authors. BJD © 2012 British Association of Dermatologists. |
Chemical References |
- Anticarcinogenic Agents
- Photosensitizing Agents
- Tetrahydronaphthalenes
- Bexarotene
- Methoxsalen
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Topics |
- Adolescent
- Adult
- Aged
- Anticarcinogenic Agents
(administration & dosage, adverse effects)
- Bexarotene
- Child
- Child, Preschool
- Combined Modality Therapy
(methods)
- Dose-Response Relationship, Drug
- Dose-Response Relationship, Radiation
- Early Termination of Clinical Trials
- Humans
- Infant
- Methoxsalen
(administration & dosage, adverse effects)
- Middle Aged
- Mycosis Fungoides
(drug therapy, pathology)
- PUVA Therapy
(adverse effects, methods)
- Photosensitizing Agents
(administration & dosage, adverse effects)
- Skin Neoplasms
(pathology, therapy)
- Tetrahydronaphthalenes
(administration & dosage, adverse effects)
- Treatment Outcome
- Young Adult
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