Is there a standard of care for intermediate and advanced stages of cutaneous T-cell lymphoma mycosis fungoides (CTCL-MF)?

Abstract

e18537 Background: Patients with CTCL-MF are treated with a variety of approaches by varying clinical specialists. None of the current approaches is curative. This study was conducted to understand the most common treatment practices for later stages of CTCL-MF in the United States. Methods: An internet-based treatment panel of 50 oncologists and dermatologists provided over 1100 independent decisions from all disease stages. Those decisions for intermediate (stage IIb) and advanced (stages III / IVa and IVb) were used to determine the representative treatment practices in the US. Results: Treatment decisions reported here were for predominantly Caucasian and male patients (60 to ≥80% for each characteristic). Systemic drug therapy, either a single drug alone or combined with another drug, was used as the primary treatment modality for most with advanced CTCL-MF. While it also was the most common selection for intermediate disease, the variety of selections indicates the difficult nature of treating this stage of MF (Table). For stage III/IVa disease, denileukin diftitox was by far the most common drug used (59%). While denileukin diftitox was also the most common choice for stage IVb, it was only used in 22% of the cases; CHOP (20%) and vorinostat (17%) were used almost as often. This heterogeneity is indicative of the refractive nature of stage IVb CTCL-MF. Conclusions: While systemic drug therapy is the preferential selection, there is still great heterogeneity in the selection of modality as well as the specific therapeutic(s) used. Taken together, these results suggest that a specific standard of care has not been identified for advanced CTCL-MF. Additional efforts aimed at identifying new efficacious therapies for advanced CTCL are needed. However, lack of a current treatment standard is an impediment to selection of the appropriate control arm in clinical trials. Treatment modality usage in CTCL-MF by disease stage. Stage IIb (n=104) Stage III/IVa n=192) Stage IVb (n=56) Systemic drug therapy 25% 72% 63% Localized XRT 20% 0% 0% Phototherapy 13% 2% 0% Skin-directed + systemic drugs 13% 6% 7% Localized (topical) drug 10% 0% 0% Multiple systemic drugs 0% 6% 18% Photopheresis 2% 11% 5%