Skin-directed therapy and biologic response modifiers in mycosis fungoides


Published: 7 May 2024
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Authors

  • Vieri Grandi Dermatology Unit, Department of Health Sciences, University of Florence Medical School, Florence; Melanoma and Skin Cancer Unit, Central Tuscany Health District, Italy. https://orcid.org/0000-0001-8201-346X
  • Virginia Alba Colantuono Dermatology Unit, Department of Health Sciences, University of Florence Medical School, Florence; Melanoma and Skin Cancer Unit, Central Tuscany Health District, Italy.
  • Nicola Pimpinelli Dermatology Unit, Department of Health Sciences, University of Florence Medical School, Florence; Melanoma and Skin Cancer Unit, Central Tuscany Health District, Italy.

The most common and widespread type of cutaneous T-cell lymphoma is mycosis fungoides (MF), and it has a multiphasic clinical and biological course, with early stages being indolent for many years and later stages being faster and more aggressive. The clinical stage has a significant impact on the management and course of treatment: in the early stages, skin-directed therapies (SDT) plus/or biologic response modifiers (BRM); in the later stages, radiotherapy and/or systemic therapies. Even though national and international societies and groups periodically update their clinical recommendations, there is still no universally accepted approach. This paper reviews and discusses the various SDT and BRM options, either separately or in combination.


Dobos G, de Masson A, Ram-Wolff C, et al. Epidemiological changes in cutaneous lymphomas: an analysis of 8593 patients from the French Cutaneous Lymphoma Registry. Br J Dermatol 2021;184:1059-67. DOI: https://doi.org/10.1111/bjd.19644

Willemze R, Cerroni L, Kempf W, et al. The 2018 update of the WHO-EORTC classification for primary cutaneous lymphomas. Blood 2019;133:1703-14. DOI: https://doi.org/10.1182/blood-2018-11-881268

Latzka J, Assaf C, Bagot M, et al. EORTC consensus recommendations for the treatment of mycosis fungoides/Sézary syndrome - Update 2023. Eur J Cancer 2023;195:113343. DOI: https://doi.org/10.1016/j.ejca.2023.113343

Kim EJ, Hess S, Richardson SK, et al. Immunopathogenesis and therapy of cutaneous T cell lymphoma. J Clin Invest 2005;115:798-812. DOI: https://doi.org/10.1172/JCI24826

Zackheim HS, Kashani-Sabet M, Amin S. Topical corticosteroids for mycosis fungoides. Experience in 79 patients. Arch Dermatol 1998;134:949-54. DOI: https://doi.org/10.1001/archderm.134.8.949

Zackheim HS. Treatment of patch-stage mycosis fungoides with topical corticosteroids. Dermatol Ther 2003;16:283-7. DOI: https://doi.org/10.1111/j.1396-0296.2003.01639.x

Kartan S, Shalabi D, O’Donnel M, et al. Response to topical corticosteroid monotherapy in mycosis fungoides. J Am Acad Dermatol 2021;84:615-23. DOI: https://doi.org/10.1016/j.jaad.2020.05.043

Henstell HH, Tober JN. Treatment of mycosis fungoides with nitrogen mustard. J Invest Dermatol 1947;8:183-8. DOI: https://doi.org/10.1038/jid.1947.24

Zackheim HS. Treatment of mycosis fungoides with topical nitrosourea compounds. Arch Dermatol 1972;106:177-82. DOI: https://doi.org/10.1001/archderm.106.2.177

Price NM, Constantine VS, Hoppe RT, et al. Topical mechlorethamine therapy for mycosis fungoides. Br J Dermatol 1977;97:547-50. DOI: https://doi.org/10.1111/j.1365-2133.1977.tb14133.x

Price NM, Deneau DG, Hoppe RT. The treatment of mycosis fungoides with ointment-based mechlorethamine. Arch Dermatol 1982;118:234-7. DOI: https://doi.org/10.1001/archderm.118.4.234

Price NM, Hoppe RT, Deneau DG. Ointment-based mechlorethamine treatment for mycosis fungoides. Cancer 1983;52:2214-9. DOI: https://doi.org/10.1002/1097-0142(19831215)52:12<2214::AID-CNCR2820521207>3.0.CO;2-H

Lessin SR, Duvic M, Guitart J, 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. DOI: https://doi.org/10.1001/2013.jamadermatol.541

Olsen EA, Hodak E, Anderson T, et al. Guidelines for phototherapy of mycosis fungoides and Sézary syndrome: a consensus statement of the United States Cutaneous Lymphoma Consortium. J Am Acad Dermatol 2016;74:27-58. DOI: https://doi.org/10.1016/j.jaad.2015.09.033

Phan K, Ramachandran V, Fassihi H, Sebaratnam DF. Comparison of narrowband UV-B with psoralen-UV-A phototherapy for patients with early-stage mycosis fungoides: a systematic review and meta-analysis. JAMA Dermatol 2019;155:335-41. DOI: https://doi.org/10.1001/jamadermatol.2018.5204

Grandi V, Baldo A, Berti E, et al. Italian expert-based recommendations on the use of photo(chemo)therapy in the management of mycosis fungoides: results of an e-Delphi consensus. Photodermatol Photoimmunol Photomed 2021;37:334-42. DOI: https://doi.org/10.1111/phpp.12658

Cotter GW, Baglan RJ, Wasserman TH, Mill W. Palliative radiation treatment of cutaneous mycosis fungoides—a dose response. Int J Radiat Oncol Biol Phys 1983;9:1477-80. DOI: https://doi.org/10.1016/0360-3016(83)90321-8

Micaily B, Miyamoyo C, Kantor G, et al. Radiotherapy for unilesional mycosis fungoides. Int J Radiat Oncol Biol Phys 1998;42:361-4. DOI: https://doi.org/10.1016/S0360-3016(98)00218-1

Chan DV, Aneja S, Honda K, et al. Radiation therapy in the management of unilesional primary cutaneous T-cell lymphomas. Br J Dermatol 2012;166:1134-7. DOI: https://doi.org/10.1111/j.1365-2133.2011.10728.x

Grandi V, Simontacchi G, Grassi T, et al. Short-term efficacy and safety of total skin electron beam therapy in mycosis fungoides: systematic review and meta-analysis. Dermatol Ther 2022;35:e15840. DOI: https://doi.org/10.1111/dth.15840

Georgakopoulos I, Papadavid E, Platoni K, et al. Clinical application of total skin electron beam (TSEB) therapy for the management of T cell cutaneous lymphomas. The evolving role of low dose (12 Gy) treatment schedule. Clin Transl Radiat Oncol 2019;15:26-30. DOI: https://doi.org/10.1016/j.ctro.2018.12.002

Hooper M, Hatch L, Seminario-Vidal L. Photodynamic therapy of mycosis fungoides: A systematic review of case studies. Photodermatol Photoimmunol Photomed 2021;37:549-52. DOI: https://doi.org/10.1111/phpp.12698

Schooneman F. Extracorporeal photopheresis technical aspects. Transfus Apher Sci 2003;28:51-61. DOI: https://doi.org/10.1016/S1473-0502(02)00100-3

Knobler R, Arenberger P, Arun A, et al. European dermatology forum - updated guidelines on the use of extracorporeal photopheresis 2020 - part 1. J Eur Acad Dermatol Venereol 2020;34:2693-716. DOI: https://doi.org/10.1111/jdv.16890

Geskin L. ECP versus PUVA for the treatment of cutaneous Tcell lymphoma. Skin Therapy Lett 2007;12:1-4.

Raphael BA, Shin DB, Suchin KR, et al. High clinical response rate of Sezary syndrome to immunomodulatory therapies: prognostic markers of response. Arch Dermatol 2011;147:1410-5. DOI: https://doi.org/10.1001/archdermatol.2011.232

Olek-Hrab K, Maj J, Chmielowska E, et al. Methotrexate in the treatment of Mycosis fungoides. a multicenter observational study in 79 patients. Eur Rev Med Pharmacol Sci 2018;22:3586-94.

Alenezi F, Girard C, Bessis D, et al. Benefit/risk ratio of lowdose methotrexate in cutaneous lesions of mycosis fungoides and Sézary syndrome. Acta Derm Venereol 2021;101:1031. DOI: https://doi.org/10.2340/00015555-3719

Willemze R, Hodak E, Zinzani PL, et al. Primary cutaneous lymphomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Ann Oncol 2013;24:vi149-vi154. DOI: https://doi.org/10.1093/annonc/mdt242

Siegel RS, Pandolfino T, Guitart J, et al. Primary cutaneous Tcell lymphoma: review and current concepts. J Clin Oncol 2000;18:2908-25. DOI: https://doi.org/10.1200/JCO.2000.18.15.2908

Cheng AL, Su IJ, Chen CC, et al. Use of retinoic acids in the treatment of peripheral T-cell lymphoma: a pilot study. J Clin Oncol 1994;12:1185-92. DOI: https://doi.org/10.1200/JCO.1994.12.6.1185

Smith BD, Wilson LD. Management of mycosis fungoides: Part 2. Treatment. Oncology (Williston Park) 2003;17:1419-28.

Whittaker S, Ortiz P, Dummer R, et al. Efficacy and safety of bexarotene combined with psoralen-ultraviolet A (PUVA) compared with PUVA treatment alone in stage IB-IIA mycosis fungoides: final results from the EORTC Cutaneous Lymphoma Task Force phase III randomized clinical trial (NCT00056056). Br J Dermatol 2012;167:678-87. DOI: https://doi.org/10.1111/j.1365-2133.2012.11156.x

Ahuja HS, Szanto A, Nagy L, Davies PJA. The retinoid X receptor and its ligands: versatile regulators of metabolic function, cell differentiation and cell death. J Biol Regul Homeost Agents 2003;17;29-45.

European Medicines Agency. Targretin. European Medicines Agency, Sci Med Health. Available from: https://www.ema.europa.eu/en/medicines/human/EPAR/targretin

Pileri A, Delfino C, Grandi V, Pimpinelli N. Role of bexarotene in the treatment of cutaneous T-cell lymphoma: the clinical and immunological sides. Immunotherapy 2013;5:427-33. DOI: https://doi.org/10.2217/imt.13.15

Ginsburg E, Hennessy K, Mhaskar R, Seminario-Vidal L. Treatment of early-stage mycosis fungoides with oral bexarotene and phototherapy: a systematic review and metaanalysis. Dermatol Ther 2022;35:e15418. DOI: https://doi.org/10.1111/dth.15418

Singh F, Lebwohl MG. Cutaneous T-cell lymphoma treatment using bexarotene and PUVA: a case series. J Am Acad Dermatol 2004;51:570-3. DOI: https://doi.org/10.1016/j.jaad.2003.05.010

Papadavid E, Antoniou C, Nikolaou V, et al. Safety and efficacy of low-dose bexarotene and PUVA in the treatment of patients with mycosis fungoides. Am J Clin Dermatol 2008;9:169-73. DOI: https://doi.org/10.2165/00128071-200809030-00005

Rupoli S, Canafoglia L, Goteri G, et al. Results of a prospective phase II trial with oral low-dose bexarotene plus photochemotherapy (PUVA) in refractory and/or relapsed patients with mycosis fungoides. Eur J Dermatol 2016;26;13-20. DOI: https://doi.org/10.1684/ejd.2015.2672

Morita A, Tetishi C, Ikumi K, et al. Comparison of the efficacy and safety of bexarotene and photo(chemo)therapy combination therapy and bexarotene monotherapy for cutaneous T-Cell lymphoma. Dermatol Ther (Heidelb) 2022;12:615-29. DOI: https://doi.org/10.1007/s13555-021-00655-0

Spaccarelli N, Rook AH. The use of interferons in the treatment of cutaneous T-Cell lymphoma. Dermatol Clin 2015;33:731-45. DOI: https://doi.org/10.1016/j.det.2015.05.008

Willemze R, et al. Primary cutaneous lymphomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018;29:iv30-iv40. DOI: https://doi.org/10.1093/annonc/mdy133

Schiller M, Tsianakas A, Sterry W, et al. Dose-escalation study evaluating pegylated interferon alpha-2a in patients with cutaneous T-cell lymphoma. J Eur Acad Dermatol Venereol 2017;31:1841-7. DOI: https://doi.org/10.1111/jdv.14366

Gosmann J, Stadler R, Quint KD, et al. Use of pegylated interferon alpha-2a in cutaneous T-cell Lymphoma: a retrospective case collection. Acta Derm Venereol 2023;103:adv10306. DOI: https://doi.org/10.2340/actadv.v103.10306

Patsatsi A, Papadavid E, Kyriakou A, et al. The use of pegylated interferon a-2a in a cohort of Greek patients with mycosis fungoides. J Eur Acad Dermatol Venereol 2022;36:e291-e293. DOI: https://doi.org/10.1111/jdv.17795

Grandi, V., Colantuono, V. A., & Pimpinelli, N. (2024). Skin-directed therapy and biologic response modifiers in mycosis fungoides. Dermatology Reports, 16(s2). https://doi.org/10.4081/dr.2024.9926

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