Bexarotene and narrowband ultraviolet B phototherapy combination treatment for mycosis fungoides

Abstract

Combination therapy for mycosis fungoides (MF) has the potential to be synergistic, improve therapeutic efficacy and reduce toxicities. We present a patient with MF who improved on combination therapy with bexarotene and narrowband ultraviolet B (NB-UVB) therapy. The patient is an 81-year-old Caucasian male who initially presented with stage IB MF. After temporary improvement with NB-UVB phototherapy, he progressed to develop plaques and tumors. Psoralen and ultraviolet A therapy was contraindicated because of ophthalmologic disease. Addition of bexarotene 300 mg daily led to rapid clinical improvement in combination with NB-UVB. Interruption of NB-UVB during a prolonged hospitalization led to a clinical flare of lesions, despite continued treatment with bexarotene. Reinitiating NB-UVB was associated with clinical improvement. This report demonstrates that combination treatment with oral bexarotene and NB-UVB therapy may represent a safe alternative for the treatment of plaque-stage MF.

Bexarotene therapy for mycosis fungoides and Sézary syndrome

“…22 There is also a case report of a patient with MF stage IB responding to bexarotene and narrow-band UVB. 23 Bexarotene in combination with ECP, PUVA and UVB appears to be safe. 24 A small series (n = 5) including two patients with SS and three patients with MF stage IB demonstrated an overall response of 80% with bexarotene and ECP.…”

“…A further retrospective study of 24 patients with folliculotropic MF (18 early stage, eight late stage) reported a response (partial or complete) in 16 patients treated with bexarotene and PUVA 22 . There is also a case report of a patient with MF stage IB responding to bexarotene and narrow‐band UVB 23 . Bexarotene in combination with ECP, PUVA and UVB appears to be safe 24 .…”

The Role of Systemic Retinoids in the Treatment of Cutaneous T-Cell Lymphoma

“…The disease flared when either bexarotene or NBUVB was discontinued, suggesting a possible synergistic or additive effect. 48 Combination trials using retinoids with other systemics, such as IFNs, have been reported by various investigators. This combination is attractive because of synergistic effects of retinoid stimulation of Th1 activity through IL-12 production and inhibition of Th2 response by IFN-alpha and IFN-gamma.…”

Evolution of Clinical and Molecular Responses to Bexarotene Treatment in Cutaneous T-Cell Lymphoma

“…A retrospective study has already reported clinical response in 8 patients with CTCL stage IA–IIB treated with low-dose oral bexarotene and PUVA therapy, but not UVB [11]. Only 1 case of a patient with MF stage IB responding to bexarotene and narrow-band UVB has already been reported [12]. For this patient, discontinuation of the narrow-band UVB therapy was associated with progression of the disease, suggesting a synergic effect of these two treatments.…”