Chlormethine gel an effective treatment option for early-stage mycosis fungoides: Study

Mycosis fungoides is a type of cutaneous T-cell lymphoma, which accounts for the majority of cases of cutaneous T-cell lymphoma. Mycosis fungoides can be classified as early-stage (IA–IIA) or late-stage (IIB or greater) disease. In early-stage mycosis fungoides, skin-directed therapies are commonly used to manage the disease. Chlormethine, or mechlorethamine, is a topical chemotherapeutic, which has been in use for over 60 years.

In 2013, the US Food and Drug Administration approved chlormethine/mechlorethamine gel (Valchlor®) for treatment of stage IA and IB mycosis fungoides. Chlormethine/mechlorethamine gel is an effective therapy; however, its use may be limited by the development of adverse cutaneous reactions. Off-label dosing modifications, as well as co-administration of topical steroids and an aggressive moisturization regimen, can be used to reduce these side-effects.

The authors reported their experience of treating 4 patients with early-stage mycosis fungoides (MF) with chlormethine/mechlorethamine (CL) gel using the Geskin regimen. BSA involvement ranged from 6-20%. CL gel was initiated at 3-times weekly and adjusted as indicated.

The results of the study are as follows:

· Significant irritation was seen in 2 patients but in the patient with a superficial erosion, improvement was seen after holding treatment and applying triamcinolone ointment to the irritated skin.

· Patients noted improvement after 1 month of treatment and BSA involvement decreased by >95% after 1 year.

Thus, the researchers concluded that CL gel is an effective treatment for early-stage MF. Side effects can be limited by flexible dosing schedules, vinegar soaks followed by occlusion, and topical steroid use as needed for irritation.

Reference:

Management of Mycosis Fungoides with Topical Chlormethine/Mechlorethamine Gel: A Columbia University Cutaneous Lymphoma Center Experience Tiffany J et. al published in the advances in dermatology and venerology.

DOI: 10.2340/00015555-3911