According to a recent article in the
Archives of Dermatology, the addition of follow-up immunotherapy to photopheresis appears to significantly improve anti-cancer responses and survival in patients with cutaneous T-cell lymphoma.
Cutaneous T-cell lymphoma is a type of Non-Hodgkin’s lymphoma (NHL). NHL is a form of cancer that begins in the cells of the lymph system. The lymph system includes the spleen, thymus, tonsils, bone marrow (spongy material inside large bones that produces blood cells), lymph nodes and circulating immune cells. The main cells in the lymph system are lymphocytes, of which there are two types: B and T-cells. Each of these cells has a very specific function in aiding the body to fight infection. NHL is characterized by the excessive accumulation of atypical (cancerous) lymphocytes. These lymphocytes can crowd the lymph system and suppress the formation and function of other immune and blood cells. Cutaneous T-cell lymphoma (CTCL) refers to the accumulation of cancerous T-cells in the skin. It is a rare type of cancer, with approximately 1,000 people in the United States diagnosed each year. CTCL is often a slowly progressive disease, initially causing dry patches of skin that may be itchy or painful. Eventually, CTCL can develop into solid masses in the skin that can spread to other organs.
Patients with stage III or stage IV CTCL are considered to be in advanced stages of cancer, for which no current standard therapy is considered curative. Treatment may consist of topical or systemic chemotherapy, radiation, photopheresis, monoclonal antibodies, immunotherapy with or without a toxin and/or retinoids (form of vitamin A) for three or more months.
Photopheresis is a type of treatment that has been evaluated since the 1980’s for the treatment of cutaneous T-cell lymphoma. Photopheresis works in the following manner: the patient’s blood is filtered in order to collect the cancerous cells. The cancer cells are then treated outside the body with a substance that becomes active when exposed to ultraviolet (UV) light. Following treatment with the light-activated substance, the cancer cells are exposed to UV light which disables them. The disabled cancer cells are then re-infused back into the patient. Through biological processes not yet determined, the treated cancer cells stimulate an immune response against the other cancer cells in the body.
Researchers from the University of Pennsylvania recently analyzed data of 47 patients with advanced stages of CTCL who were treated at their facility over the past 14 years. Patients were either treated with photopheresis only or photopheresis plus immunotherapy. Immunotherapy involves agents that stimulate the immune system. All patients were treated with at least 6 cycles of photopheresis. Thirty-one patients went on to receive one or more systemic (full-body) immunotherapy agents consisting of interferon alfa, interferon gamma and/or sargramostim, or retinoids. The group of patients who received immunotherapy had worse prognostic variables prior to therapy than the group of patients who received photopheresis only. Anti-cancer responses were achieved in 84% of patients who were treated with combination therapy, compared to 75% of patients treated with photopheresis only. Survival time was 74 months for patients treated with combination therapy, compared to 66% of patients treated with photopheresis only.
These researchers concluded that the addition of immunotherapy to photopheresis appears to enhance responses and survival time in patients with advanced stages of CTCL. Patients with advanced CTCL may wish to speak with their physician about the risks and benefits of photopheresis plus immunotherapy or participation in a clinical trial evaluating novel therapeutic approaches. Two sources of information regarding ongoing clinical trials include the comprehensive, easy to use listing services provided by the National Cancer Institute (
www.eCancerTrials.com. eCancerTrials.com also provides personalized clinical trial searches on behalf of patients.
Reference: Suchin K, Cucchiara A, Gottleib S, et al. Treatment of cutaneous T-cell lymphoma with combined immunomodulatory therapy.
Archives of Dermatology. 2002;138:1054-1060.
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