Systemic Retinoids in Cutaneous T-Cell Lymphoma: A Scoping Review of Clinical Use and Evidence Gaps
- 1Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD USA
- 2School of Medicine, Koç University, Istanbul, Turkey
- 3Department of Dermatology, Emory University School of Medicine, Atlanta, GA USA
Abstract
Introduction: Systemic retinoids are ubiquitously used in cutaneous T-cell lymphoma (CTCL), often in combination with skin-directed or systemic therapies, yet their role within contemporary multimodal treatment strategies has not been comprehensively synthesized.
Methods: We conducted a PRISMA-ScR-guided scoping review of systemic retinoids in CTCL using PubMed, Embase, Scopus, Web of Science, and the Cochrane Library through December 1, 2025. Study-level and treatment arm-level analyses characterized treatment patterns, outcomes, and reporting practices. Reported response rates were descriptively summarized after excluding case reports and case series.
Results: A total of 141 studies comprising 153 treatment arms and 3805 participants with CTCL were included. Bexarotene was the most frequently studied retinoid (113/153, 73.9%), and combination therapy predominated (100/153, 65.4%). Retinoids were used across the treatment continuum, most frequently in salvage settings (85/153, 55.6%). Among treatment arms with reported stage, advanced-stage disease more frequently incorporated bexarotene-containing combination regimens than early-stage disease (80.7% vs 50.0%; p = 0.017). Among 59 overall response rate (ORR) observations from observational studies and clinical trials, median reported ORR was 60.0% for combination therapy and 51.5% for monotherapy; by individual retinoid, median reported ORRs were 56.6% for bexarotene, 59.5% for acitretin, and 57.0% for isotretinoin. Durability and safety reporting remained inconsistent, with progression-free survival and grade ≥ 3 adverse events reported in only 13.1% and 32.0% of treatment arms, respectively.
Conclusions: Systemic retinoids remain versatile and clinically relevant components of contemporary CTCL management. Rather than functioning primarily as standalone therapies, they are commonly incorporated into multimodal treatment strategies across disease stages and therapeutic settings, with reported clinical activity across individual agents and both monotherapy and combination approaches. Heterogeneity across studies precludes comparative efficacy conclusions and underscores the need for standardized response assessment, durability endpoints, and comprehensive safety and demographic reporting.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s13555-026-01926-4.
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BibTeX
@article{bui2026systemic,
title = {{Systemic Retinoids in Cutaneous T-Cell Lymphoma: A Scoping Review of Clinical Use and Evidence Gaps}},
author = {Toan Bui and Keon Niknejad and Nicholas Urbanski and Derya Goksu Fidan and Zachary Wolner and Sima Rozati},
journal = {Dermatology and Therapy},
year = {2026},
month = oct,
doi = {10.1007/s13555-026-01926-4},
url = {https://doi.org/10.1007/s13555-026-01926-4},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Systemic Retinoids in Cutaneous T-Cell Lymphoma: A Scoping Review of Clinical Use and Evidence Gaps
AU - Toan Bui
AU - Keon Niknejad
AU - Nicholas Urbanski
AU - Derya Goksu Fidan
AU - Zachary Wolner
AU - Sima Rozati
PY - 2026
DA - 2026/10/03
JO - Dermatology and Therapy
DO - 10.1007/s13555-026-01926-4
UR - https://doi.org/10.1007/s13555-026-01926-4
AB - Introduction: Systemic retinoids are ubiquitously used in cutaneous T-cell lymphoma (CTCL), often in combination with skin-directed or systemic therapies, yet their role within contemporary multimodal treatment strategies has not been comprehensively synthesized. Methods: We conducted a PRISMA-ScR-guided scoping review of systemic retinoids in CTCL using PubMed, Embase, Scopus, Web of Science, and the Cochrane Library through December 1, 2025. Study-level and treatment arm-level analyses characterized treatment patterns, outcomes, and reporting practices. Reported response rates were descriptively summarized after excluding case reports and case series. Results: A total of 141 studies comprising 153 treatment arms and 3805 participants with CTCL were included. Bexarotene was the most frequently studied retinoid (113/153, 73.9%), and combination therapy predominated (100/153, 65.4%). Retinoids were used across the treatment continuum, most frequently in salvage settings (85/153, 55.6%). Among treatment arms with reported stage, advanced-stage disease more frequently incorporated bexarotene-containing combination regimens than early-stage disease (80.7% vs 50.0%; p = 0.017). Among 59 overall response rate (ORR) observations from observational studies and clinical trials, median reported ORR was 60.0% for combination therapy and 51.5% for monotherapy; by individual retinoid, median reported ORRs were 56.6% for bexarotene, 59.5% for acitretin, and 57.0% for isotretinoin. Durability and safety reporting remained inconsistent, with progression-free survival and grade ≥ 3 adverse events reported in only 13.1% and 32.0% of treatment arms, respectively. Conclusions: Systemic retinoids remain versatile and clinically relevant components of contemporary CTCL management. Rather than functioning primarily as standalone therapies, they are commonly incorporated into multimodal treatment strategies across disease stages and therapeutic settings, with reported clinical activity across individual agents and both monotherapy and combination approaches. Heterogeneity across studies precludes comparative efficacy conclusions and underscores the need for standardized response assessment, durability endpoints, and comprehensive safety and demographic reporting. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s13555-026-01926-4.
SN - 2193-8210
SN - 2190-9172
ER -