Chlormethine Gel is Efficient and Safe in Mycosis Fungoides Skin Lesions

Authors

  • Marios Koumourtzis Dermatology
  • Kyriaki Lampadaki
  • Maria Dalamaga
  • Evangelia Papadavid National and Kapodistrian University of Athens, Medical School, Attikon General University Hospital, 1 Rimini Street, Chaidari, GR-12462 Athens, Greece

DOI:

https://doi.org/10.2340/actadv.v102.1095

Keywords:

Chlormethine, cutaneous lymphoma, mycosis fungoides, mSWAT

Abstract

Chlormethine is a bifunctional cytotoxic alkylating agent that binds to DNA, resulting in cell death (apoptosis). Chlormethine (also known as mechlorethamine) gel (CL gel) was approved in the European Union in 2017 and was first used in 2019. The aim of the study is to examine evidence regarding the efficacy and safety of chlormethine gel in everyday clinical experience from a cutaneous lymphoma centre. Twenty-three patients with stage IA–IIB mycosis fungoides received chlormethine gel between September 2020 and May 2021. All patients started by applying the gel daily and were monitored every month. At 1, 3, 6 and 9 months, 0%, 43.47%, 56.52% and 65.22% of patients, respectively, achieved an overall response. Five out of 23 patients (21.73%) achieved near complete response at a mean time of 6 months. Chlormethine gel was given as monotherapy in 12 patients (52.17%), and in addition to systemic treatments (methotrexate and peginterferon alpha-2a) in 11 patients (47.82%). Adverse events (AE) were recorded in 43.47% of patients, but only 3 discontinued treatment, due to dermatitis. Scale down of the treatment to application 3-times per week led to better patient compliance. This study shows that chlormethine gel is effective and safe in patients with mycosis fungoides with different types of skin lesions. 

Downloads

Download data is not yet available.

References

Olsen E, Vonderheid E, Pimpinelli N, Willemze R, Kim Y, Knobler R, et al. Revisions to the staging and classification of mycosis fungoides and Sezary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization of Research and Treatment of Cancer (EORTC). Blood 2007; 110: 1713-1722.

https://doi.org/10.1182/blood-2007-03-055749 DOI: https://doi.org/10.1182/blood-2007-03-055749

Scarisbrick JJ, Quaglino P, Prince HM, Papadavid E, Hodak E, Bagot M, et al. The PROCLIPI international registry of early-stage mycosis fungoides identifies substantial diagnostic delay in most patients. Br J Dermatol 2019; 181: 350-357.

https://doi.org/10.1111/bjd.17258 DOI: https://doi.org/10.1111/bjd.17258

Trautinger F, Eder J, Assaf C, Bagot M, Cozzio A, Dummer R, et al. European Organisation for Research and Treatment of Cancer consensus recommendations for the treatment of mycosis fungoides/Sezary syndrome - update 2017. Eur J Cancer 2017; 77: 57-74.

https://doi.org/10.1016/j.ejca.2017.02.027 DOI: https://doi.org/10.1016/j.ejca.2017.02.027

National Comprehensive Cancer Network (NCCN). Clinical practice guidelines in oncology (NCCN Guidelines®) cervical cancer. [accessed 2021 Dec 1]. Available from: https://www.nccn.org/professionals/physician_gls/default.aspx.

Lessin SR, Duvic M, Guitart J, Pandya AG, Strober BE, Olsen EA, et al. Topical chemotherapy in cutaneous T-cell lymphoma: positive results of a randomized, controlled, multicenter trial testing the efficacy and safety of a novel mechlorethamine, 0.02%, gel in mycosis fungoides. JAMA Dermatol 2013; 149: 25-32.

https://doi.org/10.1001/2013.jamadermatol.541 DOI: https://doi.org/10.1001/2013.jamadermatol.541

Kim EJ, Geskin L, Guitart J, Querfeld C, Girardi M, Musiek A, et al. Real-world experience with mechlorethamine gel in patients with mycosis fungoides-cutaneous lymphoma: preliminary findings from a prospective observational study. J Am Acad Dermatol 2020; 83: 928-930.

https://doi.org/10.1016/j.jaad.2019.12.070 DOI: https://doi.org/10.1016/j.jaad.2019.12.070

Gilmore ES, Alexander-Savino CV, Chung CG, Poligone B. Evaluation and management of patients with early-stage mycosis fungoides who interrupt or discontinue topical mechlorethamine gel because of dermatitis. JAAD Case Rep 2020; 6: 878-881.

https://doi.org/10.1016/j.jdcr.2020.05.031 DOI: https://doi.org/10.1016/j.jdcr.2020.05.031

Kim EJ, Guitart J, Querfeld C, Girardi M, Musiek A, Akilov OE, et al. The PROVe study: US real-world experience with chlormethine/mechlorethamine gel in combination with other therapies for patients with mycosis fungoides cutaneous T-cell lymphoma. Am J Clin Dermatol 2021; 22: 407-414.

https://doi.org/10.1007/s40257-021-00591-x DOI: https://doi.org/10.1007/s40257-021-00591-x

Gilmore ES, Alexander-Savino CV, Chung CG, Poligone B. Incidence and types of contact dermatitis after chlormethine gel treatment in patients with mycosis fungoides-type cutaneous T-cell lymphoma: the MIDAS study. In: 4th World Congress of Cutaneous Lymphomas; 2020 Feb 12-14; Barcelona, Spain. WCCL, ISCL; 2020. Abstract number Y-04. [accessed 2021 Dec 1] Available from: http://wcclbarcelona2020.com/images/site/PROTEGIDO/Abstracts_WCCl_2020_DIGITAL.pdf.

Querfeld C, Pacheco T, Haverkos B. Binder G, Angello J, Poligone B. Treatment duration as a function of clinician-level patient volume: mechlorethamine treatment for mycosis fungoides cutaneous T-cell lymphoma (MF-CTCL). [accessed 2021 Dec 1] Available from: https://www.oncnet.com/meeting-materials/lymphoma-and-myeloma/4787.

Published

2022-06-09

How to Cite

Koumourtzis, M., Lampadaki, K., Dalamaga, M., & Papadavid, E. (2022). Chlormethine Gel is Efficient and Safe in Mycosis Fungoides Skin Lesions. Acta Dermato-Venereologica, 102, adv00730. https://doi.org/10.2340/actadv.v102.1095