Understanding TreatmentOptions in
Cutaneous Lymphoma
Cutaneous B-Cell Lymphomas
22
23
3
The advantages of watch andwait over active treatment for disease that is not
progressing are that patients donot experience themany possible side effects
associatedwith anti-cancer treatments,which cannegatively impact patients’
quality of life.Treatments are also associatedwith expenses and lifestyle burdens
for the patient.
Surgical Excision
If only a few skin lesions are present, surgery can be performed to remove the
lesions. Surgical excision is a commonly used treatment forCBCL
57,58
and
is usually sufficient to control stageT1 andT2disease.
55
Surgical removal of
lesions can completely remove the lesion andmay prevent the same lesion
from coming back.However, there is up to a 43% likelihood that the tumor
will reappear or a new tumorwill develop somewhere else.
57
Inpatientswith a
solitary or localized skin lesion, surgical excision is still considered a simple and
effective choice of treatment.
Radiation Therapy
Radiation therapy has a high rate of effectiveness,withmost patients having a
complete response (100% clearance of skin lesions).
57,58
However, about one-
half of patientswill experience a recurrence of the tumor, usually in another
location.
58
Patientswhohavemore than one lesionhave a higher risk of
recurrence than thosewith a single lesion.
External beam radiation therapy is a type of radiationwhere a special beam of
radiation is aimeddirectly at the lesion.This type of therapy is a local therapy
that only treats a specific area of the body.Patients are given a radiationdose
through a specialmachine that rotates around the patient.This rotation
allows the lesion to be accessed fromdifferent angles,whichprovides amore
complete treatment. In one study of 18 patients, almost three-quarters of
patients responded to a low-dose treatment.
59
However, some patients had to be
retreated after a fewmonths because the lesion remained or recurred.
Intralesional Therapy
Whenmany small lesions are present, a small amount of drug—usually
interferon,
37
corticosteroid, or themonoclonal antibody rituximab (Rituxan®;
described on the next page)
60
—can be injecteddirectly into the lesion.
55
This
type of treatment has only been tested in a limitednumber of patients, so there
ismuch that is still not well understood.However, in the limited studies that
have beendone, patients didnot experience adverse reactions except pain at the
injection site.The rates of complete remissionwith this treatment are high and,
in some cases, lesions other than the one injected showed regression.However,
recurrenceswere also common.
Chemotherapy
Multiagent chemotherapies used to treat non-HodgkinB-cell lymphomas
are also commonly used forCBCL.CVP (also calledCOP) andCHOP are
alternate chemotherapies given forCBCLs.CVP is a combination therapy
consisting of cyclophosphamide (Cytoxan®), vincristine (Oncovin®), and
prednisone.One of themost common chemotherapy regimens forCBCL
is calledCHOP,which is a combination ofCytoxan® (cyclophosphamide),
hydroxy doxorubicin (Adriamycin®),Oncovin® (vincristine), andprednisone.
Most patientswill respond to one of these chemotherapies, but the rates of
relapse are high.
58
Chlorambucil,CVP, andCHOP are often given in combinationwith rituximab
(Rituxan®).
61
The response rates of these treatments is slightly better than those
of the chemotherapy regimens usedwithout rituximab.
58
Biologic Therapies
Rituximabwas the firstmonoclonal antibody approved by theUSFood and
DrugAdministration (FDA) for cancer.Rituximab targets theCD20 antigen,
which is on the surface of bothnormal and abnormal cells.TheCD20molecule
is a key target for anti-cancer therapies because it is highly expressed inmost
B-cellmalignancies.Rituximab is themost common biologic drug used in
lymphoma treatment regimens, either alone or in combinationwith standard
chemotherapy regimens. For example, rituximab is used as first-line therapy
withCHOP for aggressiveB-cell lymphomas.With systemic rituximab therapy,
there is a drop in the number of normal B cells aswell as a decrease in the
malignant lymphoma cells.This is a reasonable treatment for patientswith
multiple and/or symptomatic lesions,widespreaddisease, and involvement of
sites that are not appropriate for radiotherapy, such as the head.Most patients
respond to treatment for 4 to 39months before relapse.
55,62-64
