Pegylated-interferon as an alternative to interferon-alfa 2a in cutaneous T-cell lymphoma

Abstract

Aims: Pegylated-interferon has now replaced interferon-alfa 2a, which is no longer available in the UK, for patients with cutaneous T-cell lymphoma (CTCL) refractory to skin directed therapy. We present our experience of treating 12 CTCL patients with pegylated-interferon. Methods: A retrospective review of patients with CTCL from November 2019 to June 2021 treated with pegylated-interferon at a cancer centre in the UK. Results: Twelve patients were included in the review, eight males and four females. Patients were between 48 and 84 years old with Stage IIA-IIB mycosis fungoides. Patients received a selection of prior treatments; PUVA, UV-B, gemcitabine, bexarotene, total skin electron beam therapy, localised radiotherapy, topical steroids and retinoids. All patients were started on a weekly dose of 135 μg pegylated interferon. Nine patients demonstrated a significant improvement in skin appearance and symptoms. Four patients were subsequently escalated to 180 μg due to a diminished response and one patient was dose reduced to 90 μg due to weight loss. The duration of Pegylated-interferon ranged from 1 to 17 months with six patients currently still on treatment. One patient developed progressive disease over the first month and required intravenous chemotherapy to establish control. The median time to response was 42 days. Pegylated interferon was well tolerated and no patients discontinued treatment due to toxicity. Three patients reported no significant side effects. Four patients reported mild coryzal or flu-like symptoms. Two patients reported mild gastrointestinal symptoms. One patient suffered hot flushes, shedding and thinning of the hair that was initially troublesome but subsequently settled. One patient required a 20-week interruption due to stomach pains, bowel disturbance, dizziness and breathlessness all of which resolved. Similar symptoms were previously reported in the same patient on interferon alpha-2a. One patient suffered a pulmonary embolism 13 weeks into treatment which was successfully managed. One patient died following a stroke after 36 weeks of treatment and was confirmed COVID positive. Seven patients received interferon alpha 2a prior to pegylated-interferon. Two patients were converted directly and demonstrated an improved response. One patient reported new unilateral hearing loss that resolved with ear drops, and one patient reported tinnitus and poor appetite that also resolved. Otherwise, there were no significant differences in side effects and response was maintained. Conclusion: The substitution of Pegylated-interferon for alpha interferon was associated with a high response rate with no evidence of additional toxicity.