Understanding TreatmentOptions in
Cutaneous Lymphoma
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Cutaneous T-Cell Lymphomas
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dermatologists experienced in themanagement of cutaneous lymphoma.There
are also risks including infection, blisters, skindiscoloration, andpain.
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TSEB
therapy is commonly used in combinationwith chemotherapy.
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Brachytherapy, also known as internal radiotherapy, is a newermethod for
delivering radiation in cancer treatment.The term “brachy” is from theGreek
word “brachys,”meaning short distance.Very small radioactive seeds or sources
called implants are placed in or near the tumor by computer-controlleddelivery
through a thinplastic catheter ormetal tube called an applicator.The implants
are about the size of a grain of rice.A computer controlswhere the seeds are
delivered andhow long they remain in any location.They are located so as to
harm as fewhealthy cells as possible.The radioactivematerialmay be left for a
short time ormore permanently.The applicatormay be left until all treatments
are completed.The procedure,which is done in a hospital operating room,may
only last a fewminutes.Locating the radiation source so close to the cancerous
tissue helps to spare surroundinghealthy tissue from radiation exposure. Short-
range radiation sources are used. It can be used alone or in combinationwith
other therapies such as surgery, external beam radiotherapy, or chemotherapy.
One trial investigating the use of brachytherapy in the treatment of patients
withmycosis fungoides analyzed 23 facial lesions in 10 patients.This trial
reporteddramatic clinical improvement andno recurrences in these patients
during the 6.3-month follow-upperiod; however, longer-term follow-up is still
needed.
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Systemic Therapies
Extracorporeal Photopheresis
Extracorporeal photopheresis is a treatment for disease that has traveled
beyond the skin and into the bloodstream.This treatment has similarities to
phototherapy. It is a 1.5- to 5-hour procedure, depending on the equipment
used, duringwhich a portion of the patient’s blood is removed from the vein and
placed into a portablemachine that separates thewhite blood cells,mixes them
with a photosensitizing drug (methoxsalen), and exposes them toUVA light.
The cells that are returned to the body are better able tofight infection.Patients
are typically treated on 2 successive days, 3 to 4weeks apart.
Biologics
Interferon
Interferon is a cytokine, a naturally occurring protein in the body that is
normally present in very small amounts. Interferon can also bemade in a
laboratory and used as a drug. Interferonmay be given as an injection into a
vein ormuscle, or under the skin. Interferon alfa (Intron®A [interferon alfa-2b]
orRoferon®-A [interferon alfa-2a]) or gamma stimulate the body’s immune
system tofight some types of cancer.Althoughhow it works is not fully
understood, it is thought that thesemolecules interact with receptors on the
surface of cells,where theymay interferewith the cancer cell’s ability todivide
or reduce the ability of the cancer cells to protect themselves from the immune
system, and/or theymay strengthen the patient’s immune system.Themost
common side effects are flu-like syndrome, fatigue, low blood cell counts, low
calcium or high glucose or triglycerides, changes in liver enzyme levels,weight
loss, andhair loss.
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Some patients, especially the elderly,might experience
cognitive effects thatmay include difficulty concentrating and remembering.
Peripheral neuropathy (numbness and tingling of hands and feet and sometimes
loss of taste) can also occur,which usually slowly resolveswhen themedication
is stopped.
Retinoids
Bexarotene is a retinoid that is available as a capsule that is taken orally, aswell
as being used in a skin cream.Oral bexarotene is approved by theFDA for the
treatment of patientswith refractory or persistentCTCL after trying at least
one other therapy.Themost common side effectswith use of oral bexarotene
are an increase in blood lipids and an underactive thyroid gland.When taking
oral bexarotene, your skinmay becomemore sensitive to sunlight, so you
must wear sunscreen andprotective clothingwhile in the sun.Grapefruit or
grapefruit juicemay interact with bexarotene and could cause additional side
effects.Other drugs can also interact with oral bexarotene.Patients should
checkwith their doctor or pharmacist tomake sure they are avoiding products
containing ketoconazole, itraconazole, gemfibrozil, or erythromycin, or any
othermedications thatmay interact with bexarotene.
