Brentuximab vedotin in CD30+ primary cutaneous T-cell lymphomas: a review and analysis of existing data.

BACKGROUND: The utility of brentuximab vedotin (BV) in CD30+ systemic lymphomas is established, however evidence for treating primary cutaneous lymphoma remains limited. This study aimed to evaluate BV in treating CD30+ transformed mycosis fungoides (MF) and primary cutaneous anaplastic large cell lymphoma (PC-ALCL). METHODS: A literature review was conducted, and we analyzed data from published trials and case reports obtained via search of Ovid-MEDLINE® and PubMed databases. The search yielded 372 reports, and 10 publications met inclusion criteria. Sixty-one patients with CD30+ transformed MF and seven with PC-ALCL were included. RESULTS: Mean age at BV initiation was 60.8 years (67 - PC-ALCL; 60.1 - MF), and 4.1 therapies were attempted prior to BV (3.1 - PC-ALCL; 4.2 - MF). The overall response rate was 67.7% (100% - PC-ALCL; 63.9% - MF), with 16.2% of patients experiencing complete response (100% - PC-ALCL; 6.6% - MF). Mean time to clinical response was 5.3 and 9.3 weeks for PC-ALCL and MF, respectively. Mean response duration for patients with PC-ALCL was 7.6 and 7.8 months for MF. Peripheral neuropathy (57.2%) and fatigue (35.6%) were the most commonly reported adverse effects. CONCLUSIONS: This analysis summates the current evidence regarding the use of BV in treating CD30+ MF and PC-ALCL. Preliminary results indicate that BV is effective for CD30+ CTCL, however additional studies with larger sample sizes are necessary. The study provides clinicians with the clinical context in which BV may be appropriate as well as information regarding therapeutic expectations and outcomes.

Integration of Dermatology-Focused Physical Diagnosis Rounds and Case-Based Learning within the Internal Medicine Medical Student Clerkship.

BACKGROUND: Over half of dermatologic conditions are seen by nondermatologists, yet medical students receive little dermatology education. Medical students in the clinical years of training at our institution felt insecure in their physical diagnosis skills for dermatologic conditions. OBJECTIVE: The objective of this study was to implement dermatology-focused curricula within the Internal Medicine (IM) Core Clerkship to increase student confidence in diagnosing skin diseases. METHODS: Two dermatology-focused sessions were integrated into the IM Clerkship. A faculty dermatologist leads students on a dermatology-focused physical diagnosis "Skin Rounds", where patients are seen at the bedside and students practice describing skin lesions and forming a differential diagnosis. Students also participate in a case-based active learning session. A dermatologist selects images of common skin conditions that students describe utilizing appropriate terminology and offer a differential diagnosis. The impact of these sessions was assessed through survey-based student feedback and by comparing the results from the IM Shelf Exam before and after intervention. RESULTS: A total of 74 students completed the skin rounds survey (32% response rate). About 99% (n = 73) of students felt that skin rounds were effective and useful, and 92% (n = 68) of students reported that they felt more confident in describing skin lesions afterward. A total of 43 students completed the case-based learning session survey (37% response rate), and 98% (n = 42) of students strongly agreed or agreed that the session was effective and useful. Performance on the dermatologic questions of the IM Shelf Exam was analyzed. While not statistically significant at P < 0.05, students improved from an average of 77% correct responses before intervention to 79% afterward (P = 0.60). CONCLUSIONS: Our case-based and bedside teaching interventions were met with high satisfaction from medical students and increased their confidence in describing skin lesions. This intervention can serve as a model to improve dermatology education and can be adapted to utilize the IM clerkship to address curriculum inadequacies at other institutions.