Mycosis fungoides: the therapeutic search continues

Article Abstract:

Mycosis fungoides is a rare T-cell lymphoma, a cancer of a subset of T lymphocytes that are involved in the generation of an immune response that arises in the skin. This fatal disease is first detected as lesions in the skin which can remain in the skin for years. With time, the lesions enlarge to become tumorous masses which also remain localized in the skin for years. The disease eventually progresses to the lymph nodes, the blood, and the viscera, or body organs. Once this stage of the disease is reached, the average survival time is only two years. With the more sensitive diagnostic techniques available, it has been shown that the disease spreads long before it is clinically apparent. The present conservative therapy for mycosis fungoides is treatment with drugs applied directly to the skin lesions. Since the cancer spreads early in the disease, the skin treatment is not sufficient and the majority of the patients die. Because the disease is rare, there have not been many trials of various treatments. The study by Kaye and others reported in the Dec 4, 1989, issue of the New England Journal of Medicine is a randomized trial comparing the response and survival rate of the conventional skin treatment to a more aggressive early treatment of combined radiation and chemotherapy. The study showed that although the initial response rate of the combined treatment was better than the conventional therapy, there was no difference between the two treatments in survival or the number of patients that no longer had the disease. The study did not show, however, whether there was a difference between the two therapies in the length of time the patients went without symptoms of the disease. Since the lesions of the skin are so deforming, a significant difference would justify the use of one therapy instead of another. Other innovative approaches are necessary for the treatment of mycosis fungoides.

editorial

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A randomized trial comparing combination electron-beam radiation and chemotherapy with topical therapy in the initial treatment of mycosis fungoides

Article Abstract:

Mycosis fungoides is a rare and poorly understood T-cell lymphoma, a cancer of the T lymphocytes involved in the generation of the immune response that arises in the skin. A study was conducted to determine whether early aggressive therapy slows the progression of this fatal disease. The first evidence of the disease appears as lesions in the skin, but the cancer progresses to the lymph nodes, the blood and the viscera, or body organs. Chemotherapy for patients with advanced disease yields a high initial response rate, but the response is short-lived and the majority of the patients die due to progression of the disease into the body organs or from complications such as infection. In a study of 103 patients with mycosis fungoides, treatment protocols involved either aggressive systemic combination therapy of total skin electron-beam radiation and chemotherapy with the drugs cyclophosphamide, doxorubicin, etoposide, and vincristine, which are known to be active against lymphomas, or else with a conservative treatment of the drug mechlorethamine applied to the skin. The combined therapy was considerably toxic to the patients: 12 out of 52 patients were hospitalized for fever, five had heart failures, and two developed acute nonlymphocytic leukemia. Although patients who received the combination therapy had a significantly initial higher response rate than those with the skin treatment, 38 percent versus 18 percent, after six years there was no difference in survival rate or the number of patients that were disease-free, which was less than 10 percent. Therefore, early aggressive treatment for mycosis fungoides does not improve the prognosis of patients compared to the conservative treatment to the skin.

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Chemotherapy of lung cancer

Article Abstract:

Lung cancer is the second most common form of cancer in the US. There are two types of lung cancer: small cell lung cancer and non-small-cell lung cancer. Patients with small-cell lung cancer are more likely to have cancer that has spread to other parts of the body than those with non-small-cell lung cancer. Individuals with small-cell lung cancer are usually treated with a combination of surgery or radiation therapy and chemotherapy. A small percentage of these patients may benefit from chemotherapy with a single drug, but combination chemotherapy is more effective for most patients. Most patients with non-small-cell lung cancer are treated surgically, and those with cancer metastasis may undergo radiation therapy. These patients are less likely to benefit from chemotherapy than those with small-cell lung cancer. Some may undergo chemotherapy with a single drug or combination chemotherapy despite the lack of evidence that either improves survival.

Usage, Chemotherapy, Lung cancer, Chemotherapy, Combination, Combination chemotherapy

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