Methotrexate first line, viable treatment option for effective mycosis fungoides, finds study

A new study published in the Journal of the European Academy of Dermatology and Venereology found that methotrexate (MTX) has a favorable benefit/risk ratio and is a good therapy choice for Mycosis fungoides (MF) when administered as a first-line treatment. A uncommon and varied subtype of non-Hodgkin lymphomas, cutaneous T-cell lymphomas (CTCLs) are distinguished by their distinct T-cell phenotype and clinical presentation.

The two most common main CTCL subtypes are Sézary syndrome (SS) and Mycosis fungoides. As a folate antagonist, methotrexate (MTX) works by blocking the enzyme dihydrofolate reductase, which is necessary for DNA synthesis. It is one of the most common chemotherapeutic options used to treat a variety of cancers, including CTCLs. This study by Vasiliki Nikolaou and colleagues was set out with the intention of summarizing and reporting the clinical experience of MF patients treated with low-dose MTX in tertiary experienced centers in Greece.

MF participants from 5 Greek cutaneous lymphoma referral centers participated in this retrospective multicenter investigation. Information about safety and efficacy was examined. The median (IQR) age of diagnosis for the 211 MF patients who were enrolled (68.3% of whom were male) was 68.3 (56–75) years.

There were 124 individuals with late-stage (IIB-IVB) illness (59.3%). 112 (53.1%) patients received MTX monotherapy, whereas 99 patients received combination regimens that included phototherapy, interferon, and retinoids. In 103 patients, MTX was the first-line treatment (48.9%). There was a 55.5% overall response rate (ORR), with 29.9% of patients providing full answers.

With no discernible differences between monotherapy and combination therapy, MTX showed higher efficacy as a first-line treatment than in later usage. 3.8 months (IQR 2.3–9.9 months) was the median time to greatest response. The individuals with erythrodermic disease (Stage III) had improved ORRs when compared to the ones with tumor stage disease (Stage II).

The median progression-free survival (PFS) for early-stage disease was 17.1 months, for Stage IIB disease it was 5.7 months, for Stage III it was 46 months, and for Stage IV it was 9.6 months (0.7-.). Also, 14 (6.7%) of the individuals had serious adverse (Grade 3) events that resulted in treatment termination. A weekly median dosage of 15 mg of oral MTX was administered to all patients once a week. Overall, this study provides important insights into the real-world response rates of MF patients treated with MTX.

Source:

Nikolaou, V., Panou, E., Tsimpidakis, A., Koumprentziotis, I., Patsatsi, A., Siakantaris, M., Kruger‐Krasagakis, S., Marinos, L., Georgiou, E., Lampadaki, K., Velissari, A., Daponte, A., Doxastaki, A., Kaliampou, S., Vaiopoulos, A., Konstandinou, I., Koumourtzis, M., Lakiotaki, E., Pappa, V., … Papadavid, E. (2024). Effectiveness and safety of methotrexate in the treatment of mycosis fungoides: Real‐world data from a multicentre study. In Journal of the European Academy of Dermatology and Venereology. Wiley. https://doi.org/10.1111/jdv.20350