PUVA Maintenance Therapy in Mycosis Fungoides (M_PUVA_2012)
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
|Official Title:||A Multi-center, Randomized Study on Oral 8-methoxypsoralen Plus UVA With or Without Maintenance Therapy in Mycosis Fungoides EORTC/ISCL Stage IA to IIB|
- Recurrence after complete remission within 12 months post therapy [ Time Frame: 12 months after end of therapy ]
Recurrence is defined as mSWAT (modified severity weighted assessment tool ) >0.
The primary outcome will be evaluated by survival analysis (log-rank test; Kaplan-Meier) comparing time to recurrence after complete remission between patients treated with maintenance therapy vs. patients without maintenance therapy.
- Quality of life [ Time Frame: Week -4 to 0; week 12, 24, 36, and 48; month 15, 18, 21, 24, 36, 48, 60, and 72 ]Compared to baseline
- HADS [ Time Frame: Week -4 to 0; week 12, 24, 36, and 48; month 15, 18, 21, 24, 36, 48, 60, and 72 ]Hospital anxiety depression score, compared to baseline;
- Cytokine response in serum [ Time Frame: Week -4 to 0; week 6, 12, 24, and 48 ]Compared to baseline
- Levels of regulatory T cells [ Time Frame: Week -4 to 0; week 6, 12, 24, and 48 ]Compared to baseline
- Function of regulatory T cells [ Time Frame: Week -4 to 0; week 6, 12, 24, and 48 ]Compared to baseline
- Microscopic alterations [ Time Frame: Week -4 to 0; and week 6; optional at week 12, 24, and 48; and in the follow-up from year 1 to 5 ]Quantification of histologic response in skin biopsy
- Cytokine expression in the skin [ Time Frame: Week -4 to 0; and week 6; optional at week 12, 24, and 48; and in the follow-up from year 1 to 5 ]Rt-PCR and immunohistochemical staining investigations
|Study Start Date:||February 2013|
|Estimated Study Completion Date:||October 2022|
|Estimated Primary Completion Date:||October 2021 (Final data collection date for primary outcome measure)|
Active Comparator: PUVA maintenance treatment
Psoralen plus UVA (PUVA) treatment. The patients receive a standardized dose of oral 8-methoxypsoralen (Oxsoralen) 1 hour before UVA exposure
8-methoxypsoralen 10mg per 20 kg body weight 1 hour before UVA exposure
Other Name: Oxsoralen®; Gerot Pharmazeutika GmbH, Vienna, Austria
No Intervention: No maintenance treatment
Background: Psoralen plus UVA (PUVA) photochemotherapy consists of the topical or oral application of psoralen, followed by exposure to UVA light. PUVA is used in various conditions, including early stages of mycosis fungoides (MF) and other primary and secondary lymphoproliferative disorders. PUVA has strong pro-apoptotic and immunomodulating properties, but the exact mechanisms by which PUVA leads to clearance of MF are not well understood. Although MF is generally a slowly progressing disease, it ultimately can spread to lymphoid tissues, peripheral blood, and other organs, leading to death.
Previous Work: PUVA therapy is a well-accepted first-line treatment option for skin-limited MF (stages IA, IB, and IIA), leading to complete remission in a high portion of patients (approximately 70 to 90%). Long-term remissions can be achieved with PUVA in a certain percentage of patients. However, in most cases MF lesions relapse after stop of PUVA after variable time intervals with a median time to relapse of 14 to 17 month, according to our own experience. Not only is little is known about the therapeutic mechanisms of PUVA in MF but as little is known about optimal duration and frequency of treatment (2, 3, or 4 times weekly), dose escalation, and maintenance therapy. Although PUVA has been introduced more than 30 years ago, there is lack of prospective controlled studies with clearly defined dose schemes and also an ongoing controversy whether PUVA maintenance therapy may prolong disease remission in MF upon initial complete clearance.
Hypothesis & Intended Work: We hypothesize that PUVA prolongs disease free survival in MF patients. In a randomized multicenter trial involving 9 centers in Austria, we plan to investigate (1) the clinical efficacy of PUVA and its maintenance therapy in MF and, (2) the mechanisms by which PUVA leads to disease clearance. In total, 82 patients will be enrolled and treated with a defined PUVA regimen with 2 exposures per week for 12 weeks. After 12 weeks of PUVA treatment, patients with complete remission will be randomized into two arms. In Arm A patients will be treated with PUVA maintenance therapy at constant single UVA doses. Maintenance treatment will be given once a week for one month (4 weeks), every 2 weeks for 2 months (8 weeks) and after three months once a month over 6 months. After 9 months of maintenance therapy patients will discontinue therapy. Patients in Arm B will receive no therapy. Thereafter, all patients will be followed until recurrence or at least 12 months (in non-recurrent patients) when the primary study analysis will be done. In addition, the follow-up will be extended to 60 months for long-term results.
The mechanistic action of PUVA will be studied by laboratory investigations, including immune function and cytokine analysis.
Outlook: A better understanding of the optimal regimen and the therapeutic mechanisms of PUVA in MF should help improving treatment strategies for this life-threatening disease. The understanding of the mode of action of PUVA in MF may also help to develop novel treatments using PUVA-affected pathways, allowing to achieve overall better long-term response and success.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01686594
|Medical University of Graz|
|Graz, Austria, 8010|
|Department of Dermatology, Medical University of Innsbruck|
|Innsbruck, Austria, A-6020|
|Department of Dermatology, General Hospital of the City of Linz|
|Linz, Austria, A-4021|
|Department of Dermatology, Hospital Salzburg - Paracelsus Private Medical University|
|Salzburg, Austria, A-5020|
|Department of Dermatology, County Hospital St. Pölten|
|St. Pölten, Austria, A-3100|
|Department of Dermatology, Medical University of Vienna|
|Vienna, Austria, A-1090|
|Department of Dermatology, Hospital Hietzing|
|Vienna, Austria, A-1130|
|Department of Dermatology, Klinikum Wels|
|Wels, Austria, A-4600|
|Department of Dermatology, County Hospital Wiener Neustadt|
|Wiener Neustadt, Austria, A-2700|
|Principal Investigator:||Peter Wolf, MD||Medical University of Graz|