Clinical potential of mechlorethamine gel for the topical treatment of mycosis fungoides-type cutaneous T-cell lymphoma: a review on current efficacy and safety data

Abstract

Nitrogen mustard is a chemotherapeutic agent that has a well-documented safety and efficacy profile in the treatment of cutaneous T-cell lymphoma. Development of nitrogen mustard formulations and treatment regimens has been studied extensively over the last 40 years. In the last 5 years, a new gel formulation has been developed that is associated with a decrease in delayed hypersensitivity reactions. The authors in this review found that while the gel formulation may result in a decrease of allergic contact dermatitis, this advantage has been replaced by a higher number of irritant contact reactions and a decrease in complete response rate. The gel formulation has a complete response rate of 13.8%, which is a decrease in efficacy when compared to aqueous-based preparations of similar concentrations.

C6 Ceramide (d18:1/6:0) as a Novel Treatment of Cutaneous T Cell Lymphoma

“…Adverse effects of mechlorethamine include immediate hypersensitivity reactions (allergy), erythema, hyperpigmentation, and pruritis. Secondary malignancies like cutaneous melanoma, nonmelanoma skin cancer, and primary malignancies were also reported [ 39 , 40 ]. Glucocorticoids may trigger tachyphylaxis [ 41 ] and, as CTCL patients are treated for a long time, their therapeutic potential is therefore limited.…”

<p>Management of mycosis fungoides-type cutaneous T-cell lymphoma (MF-CTCL): focus on chlormethine gel</p>

“…Several studies have reported efficacy data on treatment with mechlorethamine aqueous solutions. A recent review highlighted the difficulty in comparing them, as the frequency and duration of treatment varied, together with the use of additional therapies 46. However, the complete response (CR) rate reported was 51%–84% in T1 patients and 34%–62.2% in T2 patients 46.…”

“…Following this study, the treatment was approved by the FDA in 2013, in Israel in 2016, and in France in September 2017, after temporary individual and then cohort authorization of use since 2014. It offers the advantage of better adherence, as the greasiness of the ointment was often highlighted 46…”

“…These include DHRs developed in skin side effects and immediate hypersensitivity, ie, urticaria. Anaphylactic-type reactions following urticaria are of concern, and represent the most common reason to stop the treatment and the only contraindication 46…”

“…A recent review highlighted the difficulty in comparing them, as the frequency and duration of treatment varied, together with the use of additional therapies. 46 However, the complete response (CR) rate reported was 51%–84% in T1 patients and 34%–62.2% in T2 patients. 46 In most of these studies, topical NM was not used alone, being associated with intralesional NM in tumors, 47 , 48 localized radiotherapy, 10 , 49 electron-beam therapy, 50 or phototherapy.…”