Low-dose (12 Gy) TSEBT+Vorinostat Versus Low-dose TSEBT Monotherapy in Mycosis Fungoides

• Clinical response rate, especially complete response (CR) at week 8 as determined by an mSWAT score of 0 [ Time Frame: at week 8 from the first treatment day ] [ Designated as safety issue: No ]
• Safety and tolerability as measured by severity and frequency of adverse events [ Time Frame: at week 8 from the first treatment day ] [ Designated as safety issue: Yes ]

• To determine duration of response and time to progression as measured by the mSWAT skin assessment [ Time Frame: at week 8 from the first treatment day ] [ Designated as safety issue: No ]
• To determine pruritus response as measured by pruritus visual analog scale (VAS) Outcome Time Frame: at week 8 from the first treatment day. (Change of 3 points for more than 4 weeks will be determined to be statistically significant. [ Time Frame: at week 8 from the first treatment day ] [ Designated as safety issue: No ]

The purpose of this study is to determine if vorinostat combined with low-dose total skin electron beam therapy (TSEBT) offers superior clinical benefit (efficacy & safety) over low-dose TSEBT alone.

• Cutaneous Lymphoma
• Cutaneous T-cell Lymphoma

• Procedure: TSEBT
  12Gy
  Other Name: total skin electron beam therapy
• Drug: Vorinostat
  Calculated per patient
  Other Name: Zolinza

Inclusion Criteria:

A patient will be eligible for inclusion only if all of the following criteria apply:

1. Biopsy-confirmed mycosis fungoides, clinical stage IB-IIIB.
2. Patients must have failed or have been intolerant to at least one prior systemic or skin-directed therapy. This may include topical steroids if used as primary therapy for MF.

3.18 years of age or older.

4.Eastern Cooperative Oncology Group (ECOG) of <= 2.

5.Adequate bone marrow function: WBC > 2000/uL; platelet count > 75,000/mm3; ANC > 1000. Patients cannot be using colony stimulating factors.

6.Required wash out period for prior therapies

• Topical therapy: 2 weeks
• Systemic biologic, monoclonal antibody, or chemotherapy: 4 weeks
• Phototherapy or radiotherapy (excluding TSEBT): 4 weeks
• Other investigational therapy: 4 weeks

• Note: patients with rapidly progressive disease may be treated earlier than required washout period; however, such circumstance must be discussed and approved by the protocol director at the primary site (Stanford).

  7.Women of child-bearing potential (WOCBP) must have negative serum pregnancy test.

  8.WOCBP must agree to use effective contraception, defined as oral contraceptives, intrauterine devices, double barrier method (condom plus spermicide or diaphragm) or abstain from sexual intercourse. WOCBP includes any female who has experienced menarche and who has not undergone successful surgical sterilization or is not postmenopausal (defined as amenorrhea for 12 consecutive months).

  9.Male subjects must be willing to use an appropriate method of contraception (e.g., condoms) or abstain from sexual intercourse and inform any sexual partners that they must also use a reliable method of contraception (e.g., birth control pills) during the study.

  10.Adequate hepatic function: bilirubin <= 1.5 x upper limit of normal (ULN), AST <= 2.5 x UNL, ALT <= 2.5 x UNL, alkaline phosphatase (liver fraction) <= 2.5 x ULN

  11.Adequate renal function: creatinine <=1.5 x UNL OR creatinine clearance <=60 mL/min for patients with creatinine levels > 1.5 X institutional ULN

  12.Metabolic parameters: potassium level between 3.5 and 4.5, magnesium level between 1.5 and 2.5

  13.Ability to understand and sign a written informed consent document.

  14.Ability to comply with the treatment schedule

Exclusion Criteria:

A patient will not be eligible for inclusion if any of the following criteria apply:

1. Prior courses of TSEBT (Note: localized skin-directed radiotherapy is allowed if administered at least 4 weeks prior to initiation on study).
2. Concomitant use of any anti-cancer therapy or immune modifier.
3. Prior allogeneic or autologous transplant.
4. Active infection or have received intravenous antibiotics, antiviral, or antifungal agents within 2 weeks prior to the start of the study drug.
5. Known history of human immunodeficiency virus (HIV), hepatitis B or C.
6. History of prior malignancy with the exception of cervical intraepithelial neoplasia, non-melanoma skin cancer, and adequately treated localized prostate carcinoma (PSA <1.0). Patients with a history of other malignancies must have undergone potentially curative therapy and have no evidence of that disease for five years.
7. Patient has uncontrolled intercurrent illness, condition, or circumstances that could limit compliance with the study, including, but not limited to the following: active infection, acute or chronic graft versus host disease, symptomatic congestive heart failure, unstable angina pectoris, medically significant cardiac arrhythmia, uncontrolled diabetes mellitus or hypertension, or psychiatric conditions.
8. Recent (in the past 6 months) medically significant cardiac event (i.e. myocardial infarction, cardiac surgery.
9. Congenital long QT syndrome.
10. QTc interval > 480 msec on screening ECG.
11. Proven or suspected stage IV disease including patients with B2 (Sezary syndrome), N3 (frank LN disease), or M1 (visceral disease) categories; presence of reactive or dermatopathic lymphadenopathy (N1-2) or limited blood involvement (B1) is permitted.
12. ECOG performance status >2.
13. Pregnant or lactating.
14. Unwilling to use reliable birth control methods.
15. Any other medical issue, including laboratory abnormalities, deemed by the Investigator to be likely to interfere with patient participation.
16. Unwilling or unable to provide informed consent.