16316 Successful treatment of recalcitrant plaques and tumors in cutaneous T-cell lymphoma with combination intralesional 5-fluorouracil and topical imiquimod: A series of 8 patients

Abstract

Cutaneous T-cell lymphoma (CTCL) is generally regarded as an indolent form of cancer with treatments targeting management of symptoms and slowing progression rather than cure. While the majority of patients never develop extracutaneous disease, progression beyond the skin within 20 years of diagnosis can be up to 40%, depending on stage. Cutaneous lesions manifest as patches, plaques and tumors and the morphology and distribution of lesions largely drives treatment selection. Many patients experience a partial response to therapy and present with low density recalcitrant plaques and tumors. Regarding the use of topical 5% imiquimod for recalcitrant plaques, there are several case series, ranging from one to six patients, demonstrating complete response rates ranging from 50%-100% depending on study. Despite the well documented efficacy of intralesional 5-fluorouracil in nonmelanoma skin cancer, there are no reports of intralesional 5-fluorouracil as a treatment for CTCL. We present a case series of 8 patients with CTCL with recalcitrant thick plaques and tumors treated with combination intralesional 5-fluorouracil and topical imiquimod. A broad range of disease stages and phenotypes, including post-stem cell transplant recurrence and large cell transformed lesions were represented. Patients received between 1-5 injections 2 weeks apart of 5-fluorouracil with concomitant topical 5% imiquimod daily for a duration of 2 weeks to 3 months. Seven patients have achieved a complete response in index lesions, and one has had a good partial response after initial treatment with follow-up pending. This novel combination treatment is relatively inexpensive, well tolerated, and effective, warranting additional investigation.