Phase 1 and 2 trial of bexarotene gel for skin-directed treatment of patients with cutaneous T-cell lymphoma

Objective: To evaluate the safety, dose tolerance, and efficacy of topical bexarotene gel in patients with early-stage cutaneous T-cell lymphoma (CTCL). Design: Phase 1 and 2, open-label, dose-escalation clinical trial of bexarotene gel. Setting: Three university-based clinics. Participants: Sixty-seven adults with early-stage (TNM stages IA-IIA) CTCL. Interventions: Bexarotene gel, 0.1%, 0.5%, and 1.0%, applied in incremental dose adjustments from 0.1% gel every day to 1.0% get 4 times daily or the maximal tolerated dose. Main Outcome Measures: Patients were followed for efficacy and safety, and treatment continued as long as they benefited. Response (greater than or equal to50% improvement) was evaluated by the Physician's Global Assessment of cutaneous disease and by an overall severity assessment of cutaneous disease, including signs of CTCL and area involved. Results: Most patients tolerated topical bexarotene at 1% gel twice daily for routine use. Adverse events were generally, mild to moderate in severity and were confined to treatment sites. Treatment-limiting toxic effects were associated with skin irritation and increased with gel exposure. Patients achieved an overall response rate of 63% and a clinical complete response rate of 21%. Median projected time to onset of response was 20.1 weeks (range, 4.0-86.0 weeks), and the estimated median response duration from the start of therapy was 99 weeks. Patients with no previous therapy for mycosis fungoides responded at a higher rate (75%) than those who previously underwent topical therapies (67%). Conclusions: Bexarotene gel was well tolerated, was easily self-applied, and had a substantial response rate in treating patients with early-stage CTCL.