New Treatments for Mycosis Fungoides

Julia Scarisbrick, University Hospital Birmingham NHS Trust, UK

Mycosis fungoides is the most common type of cutaneous T-cell lymphoma (CTCL) which presents with itchy painful patches and plaques in the early stages and tumours, erythroderma or extensive blood/lymph node or visceral involvement in advanced stage disease. Currently, there are no curative therapies for CTCL and consecutive treatments tend to be given until loss of response. Eligible patients may benefit form allogeneic stem cell transplantation but durable complete responses remain infrequent. There is an urgent need for new and improved therapies in CTCL to treat symptoms such as pruritus and painful skin lesions and prolong survival. 

Treatments are broadly divided into skin-directed therapies which are first-line for early stage disease and systemic therapy including immune therapies or chemotherapies are reserved for refractory or advanced stage CTCL. Most drugs for CTCL have response rates between 30 and 40%, and response durations tend to be less than a year. Three new CTCL drugs have been approved by the EMA since 2017; chlormethine gel; mechlorethamine (Ledaga®), brentuximab vedotin; an anti-CD30 antibody-drug conjugate (Adcetris®) and mogamuzilumab a humanized, afucosylated monoclonal antibody targeting CC chemokine receptor 4 (Poteligeo®) which has helped widen treatment options.  New studies looking at drug combinations or maintenance therapies should be trialled and could offer improved quality of life and outcome in CTCL.