Low-dose oral bexarotene in combination with low-dose interferon alfa in the treatment of cutaneous T-cell lymphoma: Clinical synergism and possible immunologic mechanisms

Background: For nearly 2 decades clinicians have been treating cutaneous T-cell lymphoma (CTCL) with regimens that combine interferon alfa with retinoid compounds. In December 1999 a new retinoid, bexarotene, was approved by the US Food and Drug Administration for the treatment of CTCL. At the manufacturer's recommended dose of bexarotene (300 mg/m(2) of body surface area), it has proven to be a highly effective therapy for all stages of CTCL. Nevertheless, this close is typically associated with adverse effects including severe hyperlipidemia. Furthermore, there appears to he no standardization of dosing among physicians who treat CTCL. Observations: We present 3 representative patients, 2 with erythrodermic CTCL and 1 with follicular mycosis fungoides, who experienced the rapid clearing of skin disease while being treated with a combination of low-dose bexarotene and low-dose recombinant interferon alfa. Conclusions: Combining low-close bexarotene with low-close interferon alfa was well tolerated and led to rapid improvement in our patients. We review the clinical and biologic basis for this approach.