Combined total skin radiotherapy and immune checkpoint inhibitors: A promising potential treatment for mycosis fungoides and Sezary syndrome

Abstract

Summary Radiotherapy, particularly total skin electron beam therapy (TSEB), is one of the main pillars in the strategy for treatment of cutaneous T‐cell lymphoma (CTCL). Low‐dose TSEB has gained considerable attention since it has a minimal toxicity profile. Low‐dose TSEB has been shown to yield an overall response rate up to 95 %, although the response duration is usually short. Few studies have been published on treatment outcomes after combined treatment of CTCL with TSEB and systemic therapy. Remission rates of patients who received immune checkpoint inhibitors alone ranged from 15–38 % with a two‐year progression‐free survival of 69 %. Given that TSEB results in rapid reduction of the disease burden in almost all patients, we hypothesized that TSEB followed by immune checkpoint inhibitors might be a reasonable treatment with a sustained effect for treatment‐experienced patients with mycosis fungoides and Sezary syndrome.

Acute and sub-acute toxicity profile of ultra-hypofractionated low-dose total skin electron beam with two 4 Gy fractions for cutaneous T cell lymphoma

“…Prior studies show that low-dose TSEBT could improve disease symptoms, tumor burden, and patients' health-related quality of life (HRQL) in CTCL (Elsayad et al 2020b;Hoppe et al 2015). TSEBT can be combined with systemic therapy to improve PFS (Elsayad et al 2020a). During the COVID-19 Pandemic, the International Lymphoma Radiation Oncology Group (ILROG) suggests hypofractionated TSEBT as a valid option for patients with CTCL to reduce the overall treatment duration and exposure to COVID-19 (Yahalom et al 2020).…”

Ultra-hypofractionated low-dose total skin electron beam followed by maintenance therapy: Preliminary findings from a prospective open-label study

“… 1 Prior studies show that LD-TSEBT improves cutaneous manifestations and health-related quality of life (HRQL). 2 , 3 Hypofractionated TSEBT regimens seem to be a feasible alternative to conventional fractionation. 4 Accordingly, the International Lymphoma Radiation Oncology Group recommends ultra-hypofractionated LD-TSEBT as a compelling option during the COVID-19 pandemic to decrease therapy duration and any possible exposure to COVID-19.…”

Niedrig dosierte Ganzhautelektronenbestrahlung mit oraler Bexaroten‐Erhaltungstherapie beim kutanen T‐Zell‐Lymphom

“…PD‐1‐Hemmer (Nivolumab) und PD‐L1‐Hemmer (Pembrolizumab) werden bei rezidivierender oder refraktärer MF gut vertragen, allerdings scheint in einigen Fällen während der Behandlung eine Pseudoprogression aufzutreten [32–34]. Daher erscheinen kombinierte Ansätze wie niedrig dosierte TSEBT und moderne Immuntherapien bei MF/SS vielversprechend und sollten weiter untersucht werden [8, 35–37]. Der Histon‐Deacetylase (HDAC)‐Inhibitor Resminostat wird derzeit als Erhaltungstherapie für Patienten mit MF oder SS im fortgeschrittenen Stadium untersucht (ClinicalTrials.gov NCT02953301).…”