Pegylated liposomal doxorubicin in the treatment of mycosis fungoides.

Sir, Mycosis fungoides (MF) is the most common cutaneous T-cell lymphoma. It typically evolves from the early patch and plaque stage to the cutaneous nodular or tumour stage and sometimes visceral involvement is seen in the later stage. MF is also present in an erythrodermic variant accompanied by lymphadenopathy and peripheral blood involvement, known as Sézary syndrome (1). A number of different treatment modalities of MF are known. According to recently published guidelines (2, 3) they include skin-directed therapies, such as topical steroids, topical chemotherapy (nitrogen mustard and carmustine), narrow-band UVB, UVA-1 and radiotherapy, but also systemic therapy such as PUVA, methotrexate, retinoids, α-interferon, (either alone or combined with PUVA), systemic single and multi-agent chemotherapy, photopheresis, and monoclonal antibodies (e.g. anti-CD4). Doxorubicin is an antracycline, unencapsulated agent, which causes anti-neoplastic activity in a wide range of malignant diseases, especially haematologically cancers. Doxorubicin is a topoisomerase inhibitor and thereby inhibits DNA transcription and eventually causes cell death predominantly in cancer cells, as they have a higher concentration of topoisomerase enzyme than normal cells. It has a low therapeutic index and haematological toxicity is a common and dose-dependent side-effect. Antracyclineinduced cardiomyopathy can be irreversible and lead to congestive heart failure. The frequency of this side-effect is related to the cumulative doses of doxorubicin, which should not exceed 450–550 mg/m2 (4). Pegylated liposomal doxorubicin (LD) has a significantly different pharmacokinetic profile from the unencapsulated agents, and is associated with prolonged half-life, altered toxicity profile, and the possibility of enhanced anti-tumour activity (5). The efficacy of LD in the treatment of MF has been described in one retrospective multicentre study (6) two single-centre studies (7, 8) and two case reports (9, 10). The majority of studies have reported high efficacy of LD monotherapy in patients with MF (4–7), although this has been questioned by others (10). Here we report the outcomes and adverse effects in 6 patients all diagnosed with MF stage IB, IIB or IVA and treated with LD (CAELYXTM, Schering Plough Pharmaceuticals, Farum, Denmark).