Low-Dose Electron Beam Radiation and Romidepsin Therapy for Symptomatic Cutaneous T-CellLymphoma Lesions.

Feb 2012

Akilov OE, Grant C, Frye R, Bates S, Piekarz R, Geskin LJ.

Source

Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania Medical Oncology Branch, Centre for Cancer Research, National Cancer Institute, Bethesda.

Abstract

Background: 

Romidepsin is a structurally unique histone deacetylase inhibitor FDA-approved for therapy of relapsed or refractory cutaneous T-cell lymphoma (CTCL). Localized electron beam radiation therapy (LEBT) is standard practice in the care of patients with chronically traumatized and painful lesions. Combinational therapy of those two modalities may be beneficial for the therapy of CTCL.

Objectives: 

To report observations on supportive LEBT utilized for isolated refractory lesions in patients on romidepsin.

Methods:  Observations during a phase 2 clinical trial sponsored by the National Cancer Institute (NCI 1312) examining the efficacy of romidepsin for patients with relapsed, refractory, or advanced CTCL, stage IB-IVA mycosis fungoides (MF) or Sézary syndrome. Skin responses were assessed by evaluation of five target lesions only. Patients with objective clinical responses in target lesions who had symptomatic non-target lesions were allowed limited localized radiation to isolated lesions for symptomatic relief. Patients who received localized radiation were not considered complete responders at any point.

Results:  Five patients with advanced MF (3 had stage IIB and 2 had stage IVA2) received localized electron beam radiation to symptomatic non-target lesions while on a protocol with romidepsin. None of these patients experienced additional or unexpected toxicity. Four of the five patients demonstrated fast and durable responses. We noted that significantly lower than standard doses of electron beam radiation effectively treated symptomatic lesions in these patients.

Conclusions:  Electron beam therapy demonstrated significant responses at very low doses without additional toxicity in patients on protocol treatment with the histone deacetylase inhibitor romidepsin. This merits formal investigation in a clinical trial for potential synergy in patients with cutaneous T-cell lymphoma.

British Association of Dermatologists.

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