New and Experimental Skin-Directed Therapies for Cutaneous Lymphomas

Abstract

Primary cutaneous lymphomas (CLs) originate in the skin and should be differentiated from secondary skin infiltrates, which are manifestations of lymphomas of nodal or extranodal origin. These rare diseases include various lymphoproliferative disorders: cutaneous T-cell lymphomas, cutaneous Bcell lymphomas and some rare subtypes. As definitive cure is often not possible, it is important to control the disease and alleviate symptoms. Patients with early-stage disease limited to the skin usually require skin-directed therapies using topical agents including corticosteroids, chemotherapeutic drugs, bexarotene gel, electron beam therapy and phototherapy. Each of these are effective; however, all have some disadvantages and are associated with significant adverse events. In the field of skin-directed therapies there are interesting developments using antineoplastic compounds, the retinoid tazarotene, imiquimod, gene therapy products (adenovirus vector expressing gamma-interferon), the monoclonal anti-CD20 antibody rituximab, photodynamic therapy and 308-nm excimer laser to mention a few. This review highlights some of the promising new and experimental local therapies for primary CLs and focuses on their efficacy and side effects.

Phototherapy of mycosis fungoides

“…Comprehensive reviews on ECP have been published recently and the treatment will not be covered here (20,21). Other modalities where only small case series have been published to date include photodynamic therapy, excimer laser, and UVA1 (22)(23)(24)(25)(26)(27)(28)(29). These treatments have not found widespread application in MF because they are either limited to the irradiation of very limited skin areas, or the equipment is expensive and not widely available, or both.…”

Primary cutaneous marginal zone lymphoma

“…Topical agents are ideal for patients with multifocal disease. Class I topical glucocorticoids can induce complete responses in some patients [15,16]. Other treatment options include topical nitrogen mustard, topical imiquimod, intralesional triamcinolone, intralesional interferon, and cryotherapy [8,[17][18][19].…”

Managing Patients with Cutaneous B-Cell and T-Cell Lymphomas Other Than Mycosis Fungoides

“…Systemic rituximab monotherapy is often administered when there is multifocal disease or other therapies are contraindicated or unwanted 97–99 . Topical imiquimod, an immune response modulator, is an option in certain cases 100,101 .…”