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: Charlotte F M Hughes, Amit Khot, Christopher McCormack, Stephen Lade, David A Westerman, Robert Twigger, Odette Buelens, Kate Newland, Constantine Tam, Michael Dickinson, Gail Ryan, David Ritchie, Colin Wood, H Miles Prince
• Journal: Blood (Blood) Vol. 125 Issue 1 Pg. 71-81 (Jan 01 2015) ISSN: 1528-0020 [Electronic] United States
• PMID: 25336628 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 by The American Society of Hematology.

Chemical References

• Antineoplastic Agents
• Histone Deacetylase Inhibitors
• Interferon-alpha

Topics

• Aged
• Antineoplastic Agents (therapeutic use)
• Biopsy
• Combined Modality Therapy
• Drug Therapy (methods)
• Female
• Follow-Up Studies
• Histone Deacetylase Inhibitors (therapeutic use)
• Humans
• Interferon-alpha (therapeutic use)
• Male
• Middle Aged
• Mycosis Fungoides (drug therapy)
• Remission Induction
• Retrospective Studies
• Sezary Syndrome (drug therapy)
• Skin Neoplasms (drug therapy)
• Time Factors
• Treatment Outcome