Aggressive Systemic Therapies High Dose Mono Chemotherapy

Introduction

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.

Indication

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.

Results

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.

Comments

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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