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Combination Therapy for Cancer: Phototherapy and HDAC Inhibition

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Molecular mechanisms and physiology of disease

Abstract

Cutaneous T-cell lymphomas (CTCLs) are rare extranodal non-Hodgkin’s characterised by pleomorphic skin lesions and distinct T-cell markers. The annual incidence of these non-Hodgkin’s lymphomas are approximately 0.2–0.8/100,000 and mycosis fungoides (MF) or its leukemic variant, Sézary syndrome (SS), account for the majority of cases. CTCL is a relatively benign disease in its early stages, but survival rates decrease significantly as it progresses. As curative therapy remains elusive, the goal of therapy is preventing or slowing progression from early stages while minimising long-term toxicity associated with the treatments. Early-stage CTCL can often be controlled with skin-directed therapies including topical steroids, topical retinoids and phototherapy, while patients with late-stage or refractory MF and SS are given systemic therapies including extracorporeal photopheresis (ECP), interferon (IFN), histone deacetylase inhibitors (HDACi) and denileukin diftitox. Since no single therapy can control disease progression fully, combination therapy is employed to enhance response rates. A novel combination treatment using ultraviolet light phototherapy and HDACi has shown to be a potent radiosensitiser, allowing the use of lower radiation doses and minimising the adverse effects of phototherapy. Such combination reduces the carcinogenic risks associated with the long-term use of phototherapy. Studies have shown that HDACi, such as suberoylanilide hydroxamic acid (Vorinostat, Zolinza®), Romidepsin (Istodax®) and sodium butyrate, induce increased radiosensitivity and decreased double-strand break repair capacity. This is due to the action of HDACi modifying the chromatin compaction and thus changing DNA accessibility. By blocking deacetylation of histones, they promote an open chromatin structure altering the expression of genes involved in cell survival, proliferation, differentiation and apoptosis. As a result, there is a significant increase in the level of ultraviolet-induced apoptosis.

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Acknowledgments

The support of the Australian Institute of Nuclear Science and Engineering is acknowledged. TCK was the recipient of AINSE awards. TCK is a Future Fellow and Epigenomic Medicine Laboratory is supported by the Australian Research Council. Supported in part by the Victorian Government’s Operational Infrastructure Support Program.

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Authors and Affiliations

  1. Epigenomic Medicine, Baker IDI Heart and Diabetes Institute, The Alfred Medical Research and Education Precinct, 75 Commercial Road, Melbourne, VIC, Australia

    Jane Jisun Sung B.Sc. & Tom C. Karagiannis B.Sc. (Hons), Ph.D.

  2. Department of Pathology, The University of Melbourne, Parkville, VIC, Australia

    Jane Jisun Sung B.Sc. & Tom C. Karagiannis B.Sc. (Hons), Ph.D.

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  1. Jane Jisun Sung B.Sc.
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  2. Tom C. Karagiannis B.Sc. (Hons), Ph.D.
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Correspondence to Tom C. Karagiannis B.Sc. (Hons), Ph.D. .

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  1. Department of Surgery Molecular cardiology and Angiogenesis, University of Connecticut School of Medicine, Farmington, Connecticut, USA

    Nilanjana Maulik

  2. Epigenomic Medicine, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia

    Tom Karagiannis

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Sung, J.J., Karagiannis, T.C. (2014). Combination Therapy for Cancer: Phototherapy and HDAC Inhibition. In: Maulik, N., Karagiannis, T. (eds) Molecular mechanisms and physiology of disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0706-9_17

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