by Stuart R. Lessin, M.D. Director of Dermatology, Fox Chase Cancer Center, Philadelphia, PA
The 63rd Annual Meeting of the Society for Investigative Dermatology (SID) took place in Los Angeles, California from May 16-19, 2002. Investigators from around the world submitted over 850 original abstracts. New findings related to CTCL were well represented.
In an address to the Society, Dr. Richard Edelson, Professor and Chairman of the Department of Dermatology at Yale University, presented new findings pertaining to the mechanisms underlying the therapeutic effects of photopheresis. Experiments conducted by the Yale research team have shown that photopheresis may be more effective if the re-infusion of treated blood cells is delayed for a period of time. Clinical trials will be required to determine how beneficial new photopheresis treatment regimens will be.
Dr. Youn Kim, Professor and Director of the Cutaneous Lymphoma Program at Stanford University, provided a state-of-the-art lecture on CTCL prognostic factors and therapies to the entire Society. She reported that the current staging system, developed in 1978, still provides the best prognostic information; that is, the extent of skin involvement at the time of diagnosis still is the best indicator of how a patient will fare with his or her disease. For advanced stages of CTCL, the International Society is developing additional blood staging categories that more accurately reflect the amount of blood involvement for Cutaneous Lymphoma. This will aid in treatment decision-making and in evaluating treatment results in clinical trials. Dr. Kim also announced that a new clinical trial, testing a therapeutic vaccine that targets the T-cell receptor on CTCL cells, would be starting this summer at Stanford University.
In other presentations, the Stanford group reported the long-term outcome of 525 patients with CTCL that were treated and followed at their institution for up to 30 years. Patients with limited disease (less than 10% of body surface area involvement or T1) had the same overall survival rate as controls without CTCL. Patients who were older and had advanced disease or extracutaneous disease at the time of diagnosis were at the greatest risk of progression. The Stanford Group also reported their long-term experience with topical nitrogen mustard treatment by reviewing the results of 203 patients treated at Stanford. They show that 93% of patients with T1 disease responded to treatment (65% completely) by ten months, on average. For patients with greater than 10% of the body surface area involved (T2), the response rate was 72% (34% completely) by 19 months, on average. Approximately 83-85% from both groups were free from progression of disease at ten years. Less than 10% of all treated patients experienced allergic reactions to nitrogen mustard when treated with ointment-based, compared to 6% with aqueous or water-based preparations.No patients developed secondary skin cancers attributable to topical nitrogen mustard.
Other groups reported on newly characterized defects in immunity that may help our understanding of the cause of CTCL, and in designing new immunotherapies. Also, several groups reported on their work of identifying specific receptors on CTCL cells that, when activated, results in cell death. These receptors appear to interact with therapeutic agents, such as bexarotene (Targretin®) and may explain how retinoids may be involved in enhancing CTCL cell death.
Patients and physician interacting at SID meeting
Drs. Robert Knobler and Franz Trautinger from the Department of Dermatology, University of Vienna Medical School Division of Special and Environmental Dermatology
Judith Shea discussing poster with Kathy MacDonald, Steve Froberg, Charlotte and Maurice Hamm