Topical Chemotherapy in Cutaneous T-cell Lymphoma

Lessin, Stuart R.; Duvic, Madeleine; Guitart, Joan; Pandya, Amit G.; Strober, Bruce; Olsen, Elise A.; Hull, Christopher M.; Knobler, Elizabeth; Rook, Alain H.; Kim, Ellen J.; Naylor, Mark F.; Adelson, David; Kimball, Alexa B.; Wood, Gary S.; Sundram, Uma; Wu, Hong Gyun; Kim, Youn H.

doi:10.1001/2013.jamadermatol.541

Cited by 148 publications

(115 citation statements)

References 29 publications

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“…In both the intent-to-treat population and the efficacy-evaluable population, the CR rates were between 11.5% and 18.9% in the combined gel and ointment arms. 11 As mentioned above, Price et al reported a CR rate of 17.6%–27.3% in patients with Stage IA–IB treated with ointment-based mechlorethamine at concentrations of 0.01%. 16 It is unclear as to why the CR rates for the gel and ointment preparations in this study are lower compared to the CR rates with aqueous-based preparations of mechlorethamine.…”

Section: Methodsmentioning

confidence: 90%

“… 16 More recent studies with both ointment and gel preparations by Lessin et al focus on both spot treatment and total body treatment depending on the stage of the disease. 11 …”

Section: Methodsmentioning

confidence: 99%

“…The new gel formulation is associated with irritation, hyperpigmentation, pruritus, erythema, and contact dermatitis. 11 , 12 Additionally, other studies have both refuted and documented a change in incidence of secondary skin cancers or systemic manifestations of therapy with topical NM. 4 , 6 – 8 , 11 , 13 This article serves to provide a comprehensive review of both the safety and efficacy of mechlorethamine gel compared to other NM formulations in treatment of the early stages of the MF-type of CTCL.…”

Section: Introductionmentioning

confidence: 99%

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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

Liner¹,

Brown²,

McGirt³

2018

DDDT

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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.

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Section: Methodsmentioning

confidence: 90%

“… 16 More recent studies with both ointment and gel preparations by Lessin et al focus on both spot treatment and total body treatment depending on the stage of the disease. 11 …”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

Liner¹,

Brown²,

McGirt³

2018

DDDT

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“…The effect of narrowband UVB on reduction of pruritus has been reported, but limited data are available in the context of CTCL [49, 50]. Other topical anti-lymphoma treatments such as carmustine, retinoids, and mechlorethamine (nitrogen mustard) have demonstrated effectiveness in inducing objective responses in early-stage MF, but may induce skin-directed adverse events that exacerbate pruritus rather than relieve it [5, 31, 51, 52]. Interestingly, a case series of 11 patients with CTCL treated with topical mechlorethamine resulted in the disappearance of pruritus [53].…”

Section: Clinical Studies Of Systemic Anti-lymphoma Agents Includingmentioning

confidence: 99%

Pruritus Reduction with Systemic Anti-lymphoma Treatments in Patients with Cutaneous T Cell Lymphoma: A Narrative Review

Field

Gao

Motwani

et al. 2016

Dermatol Ther (Heidelb)

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Cutaneous T-cell lymphomas (CTCL) are a heterogeneous and relatively rare group of non-Hodgkin lymphomas arising from neoplastic skin-homing memory T cells. There is no known cure for CTCL, and current treatments focus on achieving and maintaining remission, controlling symptoms, limiting toxicities and maintaining or improving quality of life. Patients with CTCL often suffer from pruritus (itching), which can be debilitating and can have a significant impact on physical well-being and quality of life. Although progress has been made towards understanding the mechanisms of pruritus, the pathophysiology of CTCL-related pruritus remains unclear. Currently, there is neither a step-wise treatment algorithm for CTCL nor a standardized approach to treating pruritus in patients with CTCL. Treatments which specifically target pruritus have been reported with varying effectiveness. However, systemic treatments that target CTCL have the potential to alleviate pruritus by treating the underlying disease. Several systemic CTCL treatments have reported anti-pruritic properties, some in both objective responders and nonresponders, but the lack of a standardized method to measure and report pruritus makes it difficult to compare the effectiveness of systemic treatments. In this review, we provide an overview of approved and investigational systemic CTCL treatments that report anti-pruritic properties. For each study, the methods used to measure and report pruritus, as well as the study design are examined so that the clinical benefits of each systemic treatment can be more readily evaluated. Funding: Financial support for medical editorial assistance and article processing charge were provided by Celgene Corporation.

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“…This was based on the additional information provided by a recent randomized, controlled, multicentre trial on 260 patients testing the efficacy of a 0Á02% gel in mycosis fungoides. 3 The timely publication by Lindahl et al 4 on a 30-year population-based follow-up study evaluating the possible long-term side-effect profile of the use of nitrogen mustard in the treatment of mycosis fungoides is an important contribution to the overall safety evaluation of this important agent for the treatment of this disease. Even though the data reported in the first study showed no evidence of systemic absorption, which may in the long term contribute to toxic side-effects, there is no doubt that local cytotoxic efficacy is associated with local absorption and should always be taken into consideration when used in early disease and young patients.…”

Section: Original Article P 699mentioning

confidence: 99%

Nitrogen mustard revisited

Knobler

2014

Br J Dermatol

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References1 Storm A, Andersen SE, Benfeldt E, Serup J. One in 3 prescriptions are never redeemed: primary nonadherence in an outpatient clinic. J Am Acad Dermatol 2008; 59:27-33. 2 Storm A, Benfeldt E, Andersen SE, Serup J. A prospective study of patient adherence to topical treatments: 95% of patients underdose. J Am Acad Dermatol 2008; 59:975-80. 3 Hix E, Gustafson CJ, O'Neill JL et al. Adherence to a five day treatment course of topical fluocinonide 0.1% cream in atopic dermatitis. Dermatol Online J 2013; 19:20029. 4 Callis Duffin K, Yeung H, Takeshita J et al. Patient satisfaction with treatments for moderate-to-severe plaque psoriasis in clinical practice. Br J Dermatol 2014; 170:672-80. 5 Saurat JH, Stingl G, Dubertret L et al. Efficacy and safety results from the randomized controlled comparative study of adalimumab vs. methotrexate vs. placebo in patients with psoriasis (CHAM-PION). Br J Dermatol 2008; 158:558-66. 6 Atkinson MJ, Kumar R, Cappelleri JC, Hass SL. Hierarchical construct validity of the treatment satisfaction questionnaire for medication (TSQM version II) among outpatient pharmacy consumers.

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Topical Chemotherapy in Cutaneous T-cell Lymphoma

Cited by 148 publications

References 29 publications

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

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

Pruritus Reduction with Systemic Anti-lymphoma Treatments in Patients with Cutaneous T Cell Lymphoma: A Narrative Review

Nitrogen mustard revisited

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