A Study of Bexarotene Combined With Radiotherapy in People With Mycosis Fungoides
Cutaneous T-cell Lymphoma
About this trial
This is an interventional treatment trial for Cutaneous T-cell Lymphoma focused on measuring Bexarotene, Radiotherapy, Mycosis Fungoides, 21-501
Eligibility Criteria
Inclusion Criteria:
- Age ≥18 years
- Pathologically confirmed cutaneous T-cell lymphoma consistent with mycosis fungoides (MF) based on biopsy done or reviewed at MSKCC
- Stage IB or higher MF per ISCL/EORTC criteria; concurrent diagnosis of Sézary syndrome permissible. Patients who have not had prior systemic therapies and refractory/relapsed patients are eligible.
- Baseline mSWAT score of at least 10
- Stable topical steroids or systemic antipruritic agent (e.g. antihistamines, doxepin, GABA analogs) preceding study entry is permissible, but no new prescribed or over the counter topical or systemic anti-pruritics started post-enrollment
- Eastern Cooperative Oncology Group (ECOG) performance status of 0-2
- Ability to provide informed consent
Exclusion Criteria:
- Any oral retinoid therapy for any indication within 3 weeks of the first dose of study drug
- Prior TSEB (prior focal skin-directed RT acceptable)
- Concurrent diagnosis of systemic anaplastic large cell lymphoma (ALCL) or another non-Hodgkin lymphoma
- Concurrent diagnosis of additional non-skin malignancy
- Pregnancy
- Patients unwilling to use two forms of barrier contraception while taking study medication
- Receipt of treatment with another investigational device or drug (at present or within 2 weeks of enrollment)
- Familial hypertriglyceridemia or other medical conditions in which use of bexarotene would be contraindicated
- High likelihood of protocol non-compliance (in opinion of investigator)
- Systemic steroids within two weeks of first dose of study drug (patients on systemic steroids for non-disease related conditions will be permitted per investigator discretion)
Prohibited concurrent medications
- Gemfibrozil is contraindicated as may increase bexarotene concentrations
- Bexarotene is a minor CYP3A4 substrate: avoid strong/moderate CYP3A4 inducers and inhibitors, if possible, but concomitant use is not a contraindication Bexarotene is a moderate CYP3A4 inducer: avoid concurrent administration with CYP3A4 sensitive substrates, for which minimal concentration changes may lead to therapeutic failures of the substrate (e.g. cyclosporine, tacrolimus, sirolimus, quinidine, fentanyl), if possible
Sites / Locations
- Memorial Sloan Kettering Cancer Center (All Protocol Activities)Recruiting
Arms of the Study
Arm 1
Experimental
Bexarotene Combined With Radiotherapy
Patients will be initiated on bexarotene 150 mg daily on Day 1, with dose increase to 300 mg daily on Day 15. Patients will receive Cycle 1 of TSEB on Day 22 (with 2 Gy given on two consecutive days -Day 22 and 23), with safety assessment on Day 52. Efficacy will first be assessed on Day 52 and then again on Day 82 by global response assessment, including mSWAT. Patients who have less than 70% reduction from baseline mSWAT score will be eligible for subsequent cycles of TSEB (administered as 4 Gy over 2 consecutive days), until mSWAT score reduction of ≥ 70%, and up to a total of 6 cycles. Treatment may continue until disease progression, unacceptable toxicity, recommended termination by treating physician, or termination of the study.