Aggressive Systemic Therapies High Dose Mono Chemotherapy

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High dose mono-chemotherapy implies an intravenous systemic application of a cytotoxic drug candidates for this type of therapy are methotrexate (63) and liposomal doxorubicin (64).

Mode of Action

Methotrexate is an inhibitor of the enzyme dihydrofolate reductase. Liposomal doxorubicin is a new formulation of adriamycin. Both have significant antitumor activity.

Practical Application

Due to the beneficial side-effect profile, we today recommend only liposomal doxor-ubicin as a mono-chemotherapy for cutaneous lymphoma. It can be given in a dosage of 20mg/m2 body surface every two or four weeks.


We recommend liposomal doxorubicin for tumor stage MF but also for other multi-lesional lymphomas that are resistant to other milder approaches such as low dose methotrexate and cannot be irradiated.


Liposomal doxorubicin can induce partial and complete remissions in more than 70% of the cases (64) (Fig. 2).

Combination with Other Modalities

There are few reports on the simultaneous application of liposomal doxorubicin and IFN-a. It is not known whether this improves the results.


Since there is no treatment modality for advanced stages of cutaneous lymphoma whose effectiveness has been shown in evidence/based fashion, we recommend administering this type of treatment only in the context of controlled clinical trials, preferentially organized by a large organization such as the international society of cutaneous lymphoma or the European Organization for Research and Treatment of Cancer (EORTC).

Figure 2 Mycosis fungoides before (left) and after (right) treatment with liposomal doxorubicin.

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