Topical chlormethine gel in the treatment of mycosis fungoides: A single‐center real‐life experience and systematic review of the literature

Abstract

Gel formulation of chlormethine (CG) has gained a preeminent role among therapies available for mycosis fungoides (MF). To evaluate the frequency of use of CG for MF treatment and to determine the limits and potentialities of CG in a real-world setting.A systematic review of articles published prior to October 2021 was performed. Articles were included in the review if a full-text English version was available. MEDLINE (PubMed), Scopus, and Web of Science were each queried from their date of inception with the following terms: "mechlorethamine gel", "chlormethine gel", and "mycosis fungoides". The reference lists of the studies retrieved were searched manually. Moreover, this study included all consecutive patients with different stages of MF (from IA to IIB) who started treatment with CG gel between July 2020 and May 2021. Data of the literature were compared to our single-center real-life experience.Of the surveyed literature, 11 publications were included in the final analysis describing a total of 548 patients with MF. Eleven patients with a median (standard deviation) age of 66 years (15.1) were enrolled and followed up, receiving CG (0.02% chlormethine HCl). Response to treatment resulted higher (90.1%) in our study population than in other real-world experiences published in literature. This systematic review supports the role of CG for MF treatment, showing its limits and potentialities. Our single-center real-life experience revealed an elevated percentage of clinical response with high safety and tolerance, demonstrating its versatile use with dose and application rate adaptability. K E Y W O R D S drug-related side effects and adverse reactions, lymphoma, mechlorethamine, mycosis fungoides, nitrogen mustard compounds, cutaneous T-cell lymphoma Primary cutaneous T-cell lymphomas (CTCLs) represent a heterogeneous group of lymphoproliferative disorders involving almost exclusively the skin. 1 Mycosis fungoides (MF) is the most common entity, consisting in

Effectiveness and tolerability of chlormethine gel for the management of mycosis fungoides: a multicenter real-life evaluation

“…In real-life management of MF, patients with early-and advancedstage disease are prescribed more flexible CL gel regimens than those reported in the pivotal study, providing also combined treatment with low-frequency TCS application or radiotherapy or other treatments (15,18,19,24). However, with the exception of the PROVE study, real-life data on CL gel use and side effect management in clinical practice are limited mainly to small populations or case series (12,(25)(26)(27)(28)(29)(30). Our study included 79 patients, representing one of the largest patient cohorts in reference to available real-life studies.…”

“…Currently, topical chlormethine (CL), an alkylating agent used successfully in the treatment of cutaneous T-cell lymphoma since the 1950s, represents the first-line treatment for early-stage patients, according to recommendations by the National Comprehensive Cancer Network and international guidelines ( 1 , 9 – 11 ). CL acts by a cytotoxic mechanism on DNA, predominantly altering the neoplastic cell growth and increasing the immunogenic potential of the host ( 12 , 13 ).…”

A Narrative Review of the State of the Art of CCR4-Based Therapies in Cutaneous T-Cell Lymphomas: Focus on Mogamulizumab and Future Treatments

“…Compound [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , …”

“…MF is characterised by indolent behaviour in the early stages, while advanced phases are regarded as an aggressive disease like SS [ 5 , 6 , 7 , 8 , 9 ]. Based on such clinical behaviour, it is unsurprising that skin-directed therapies are recommended in early MF, while systemic drugs are warranted in SS and advanced MF [ 10 ]. However, despite scheduled therapies, the clinical outcome of advanced MF and SS has been invariably bad, with an estimated overall survival (OS) ranging from 4.7 to 1.4 years, according to the literature data [ 11 , 12 , 13 , 14 ].…”

Mechlorethamine Hydrochloride Gel in the Treatment of Mycosis Fungoides–Type Cutaneous T-Cell Lymphoma (MF-CTCL): A Focus on Patient Selection and Special Considerations

“…Most patients receive at least two treatments prior to NM gel, with topical steroids, topical or systemic retinoids, and phototherapy being the most frequently reported therapies. 18,27 In a narrative review from four international expert treatment centers, NM gel was most frequently prescribed for patients with earlystage MF either after failure of high-potency topical steroids, or in those patients for whom phototherapy is contraindicated (for example because of history of melanoma). 20 NM gel can be used for spot treatment for patients with limited or localized MF (e.g., stage IA), or as a full body treatment for those with more widespread involvement (e.g., stage IB).…”