Temozolomide for central nervous system involvement in mycosis fungoides. (14th August 2015)

• Record Type: Journal Article
• Authors: Bird, Thomas G.; Whittaker, Sean; Wain, Elizabeth M.; Child, Fiona; Morris, Stephen L.
• Is Part Of: International journal of dermatology. Volume 55:Number 7(2016)
• Page Start: 751
• Page End: 756
• Publication Date: 2015-08-14
• Subjects: Dermatology -- Periodicals; 616.5
• DOI: 10.1111/ijd.13007
• Languages: English
• ISSNs: 0011-9059

Abstract

Summary: Background: The central nervous system (CNS) is one of the most commonly involved sites in the systemic progression of primary cutaneous T cell lymphomas (CTCLs) such as mycosis fungoides (MF). There is no consensus on the treatment of CNS progression in CTCL, but survival of 3–6 months is suggested when methotrexate‐based chemotherapy and/or CNS irradiation is used. Temozolomide is active in earlier stages of MF and readily crosses the blood–brain barrier. There are no published data on its use in MF patients with CNS involvement. Methods: Four MF patients were treated with oral temozolomide (200 mg/m 2 per day for 5 d on a 28‐day cycle) for CNS progression. Two patients received temozolomide with low‐dose CNS irradiation as initial treatment, and two received temozolomide following disease progression after methotrexate‐based chemotherapy and CNS irradiation. All patients received dexamethasone. Results: Temozolomide was well tolerated; there were no treatment withdrawals or dose reductions caused by toxicity. Patient 1 had an excellent partial response in pre‐irradiated disease. Patient 2 showed disease stabilization following irradiation. Patient 3 showed a complete response after a partial response to irradiation. Patient 4 demonstrated continued stabilization after a partial response to irradiation. Overall survival ranged from 10 to 33 months. Patient 3 remains alive and symptom‐free at 23 months following treatment. Conclusions: Temozolomide following low‐dose CNS irradiation appears to be well tolerated and effective in MF patients with CNS progression. It may represent a less toxic alternative to chemotherapy containing methotrexate or an option for second‐line therapy.