Review Article

Transitioning to Pegylated Interferon for the Treatment of Cutaneous T-Cell Lymphoma: Meeting the Challenge of Therapy Discontinuation and a Proposed Algorithm

Table 1

Summary of literature review of PEG-IFN treatment in CTCL.

Reference, yearnSex (♂,♀)Age (med, range)Prior therapiesCombined therapiesPathology diagnosisStageResponsePEG-IFN dosePEG-IFN treatment duration in weeks (median, range)Reasons for discontinuation (if applicable)Adverse effectsOutcomeComments

Walker et al., 2021 [25]74, 358, 38–79TCS, topical nitrogen mustard, NB-UVB, local radiation therapy, total skin electron beam therapy, alemtuzumab, MTX, topical calcipotriene/betamethasone, cyclosporine, systemic steroidsPhototherapy5, MFIIB or higher1, CR1.5 μg/kg/week–9 μg/kg/week10, 2–40Disease progression, heart failure, neutropenia, infectionConstitutional symptoms (100% of patients)Progression-free survival median, 3.5 monthsPatients had no previous interferon therapy. Study concluded that the dose of 9 μg/kg of PEG-IFN is too high and the clinicians employ a dose of 1.5 μg/kg
2, SS4, PRAverage dose = 3.76 μg/kg/weekHematologic abnormalities (100% of patients)6 dead
2, SD1 alive

Schiller et al., 2017 [26]44.064.5, 33–71PUVA, TCS, retinoidsNoneMF1, IA2, CR180 μg/week1275% of patients experienced at least 1 AEOne case of dose-limiting toxicity due to grade 3 elevation of liver enzymes. Dose-related increase in clinical response was not demonstrated
3, IB2, SDHematologic abnormalities, liver toxicity
65.158.5, 48–74PUVA, TCS, IFN, retinoidsNoneMF4, IA4, CR270 μg/week1283% of patients experienced at least 1 AE. Hematologic abnormalities, constitutional symptoms, liver toxicity, GI symptoms
2, IB1, PR
1, SD
32.159, 29–74PUVA, TCS, retinoidsNoneMF2, IA1, CR360 μg/week12100% of patients experienced at least 1 AE. Hematologic abnormalities, constitutional symptoms, liver toxicity, GI symptoms
1, IB1, PR
1, SD
Hüsken et al., 2012 [24]98.158.75, 36–75PUVA ± IFN α-2aPUVAMF2, IA4, CRIntended 1.5 μg/kg/week42.9, 8–82Disease progression (1), toxicity (2), 1 CTC grade, (3) depression, (1) exacerbation of psoriasis, one dose modification due to grade III constitutional side-effectsConstitutional, 77.8%Progression free survival 30.96 ± 4.9 monthsComparison between PEG-IFN + PUVA and IFN + PUVA showed overall response (CR + PR), which was higher in the PEG-IFN group (88.8%. vs. 50%)
3, IB4, PRMean = 1 μg/kg/week (mean cumulative dose of 3562.2 μg)Neuropsychiatric, 55.5%5-year relapse-free survival 75%
2, IIA/IIB1, PD
Gastrointestinal, 77.8%
1, III
Hepatotoxicity, 77.8%
1, IVMyelosuppression, 77.8%

Fujimura et al., 2007 [27]11.060PUVA, retinoids, intralesional IFN-γNoneMFCR180 μg/week2 yearsNone reportedAlive

Yanagi et al., 2006 [28]11.067TCS, PUVA, retinoidsOral ribavirin, continued PUVA and retinoids for 4 weeks after initiation of PEG-IFNMFPlaque stageCR80 μg/week4 weeksNone reportedAlivePatient had chronic HCV infection, which was primary reason for initiation of PEG-IFN + ribavirin

Fujimura et al., 2006 [29]10.172Total body electron beam therapyNoneCD8+ MFCR after reinitiating PEG-IFN180 μg/week6 weeksLiver enzyme elevation (ALT 165 IU/L), grade IHepatotoxicityCD8+ MF was preceded by parapsoriasis en plaque

Patstati et al., 2021 [30]3119.1262.6Not specified, PEG-IFN was 3rd line treatment in 21 patients, 2nd line in 8, 1st line in 211, monotherapy with PEG-IFNMF (26), folliculotropic MF (5)5, IA3, CR135 μg/week (9) 180 μg/week (22)Mean duration was 3.4 months prior to discontinuation in 9 patients. 8 reduced dose due to intoleranceNeutropenia (16), fatigue (9), anemia (4)In cohort of 13 patients who switched from IFN-α-2a to PEG-IFN, 4 presented with fatigue and neutropenia
4, baroxetene12, IB14, PR
4, acitretin1, IIA2, PD
4, MTX7, IIB11, SD
8, topical chemotherapy3, III
3, IV
1, discontinued
Lampadaki, 2021 [31]10.170PUVA + clobetasolClobetasol, chlormethine gelFolliculotropic MFIBPR180 μg/weekOngoing (as of publication)AliveThe use of chlormethine gel was highlighted in this publication as an additional therapy for patients with stage IB and IIB MF who have failed previous treatment
Acitretin
TSEC
IFN-α
MTX
11.066IFN-α-2b + clobetasolClobetasol, chlormethine gelFolliculotropic MFIIBCR180 μg/weekOngoing (as of publication)Alive
MTX + clobetasol

Bakar et al., 2015 [32]10.133TCSPUVAMFIAPR50 μg/m2/week7.5 months ongoing (as of publication)AliveCase report of a patient with tumor-stage MF of the vulva treated with local RT followed by IFN and then transitioned to PEG-IFN
NBUVB
PUVA
Acitretin
Local RT + total body NBUVB
IFN-α

TCS, topical corticosteroids; NB-UVB, narrow-band ultraviolet B; MTX, methotrexate; IFN, interferon; PEG-IFN, pegylated interferon; CR, complete resolution; PR, partial resolution; SD, stable disease; PD, progressive disease; PUVA, psoralen + ultraviolet A; HCV, hepatitis C virus.