Cancer Management and Research (Nov 2022)
Mechlorethamine Hydrochloride Gel in the Treatment of Mycosis Fungoides–Type Cutaneous T-Cell Lymphoma (MF-CTCL): A Focus on Patient Selection and Special Considerations
Abstract
Caitlin Crimp,1 Ameya Gangal,2 Erica S Tarabadkar,3 Michi M Shinohara1,4 1Division of Dermatology, University of Washington, Seattle, WA, USA; 2School of Medicine, Emory University, Atlanta, GA, USA; 3Department of Dermatology, Emory University School of Medicine; Winship Cancer Institute, Atlanta, GA, USA; 4Fred Hutchinson Cancer Center, Seattle, WA, USACorrespondence: Michi M Shinohara, University of Washington, 1959 NE Pacific St., Box 356524, Seattle, WA, 98195, USA, Tel +1 206-616-8523, Fax +1 206-598-4768, Email [email protected]: Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma (CTCL) and often has an indolent course, particularly for patients presenting with early-stage (patch/plaque) disease. Early-stage MF is primarily managed with skin-directed therapies. Topical mechlorethamine hydrochloride (nitrogen mustard [NM]) gel has increased tolerability compared to prior NM formulations, though contact dermatitis remains a common side effect. The addition of topical steroids can improve tolerability while maintaining the efficacy of NM gel. Real-world experience supports that NM gel also has a role in combination therapy and as adjunctive therapy in advanced-stage disease. Here we review factors that may influence patient selection for use of NM gel, including MF variants, special patient populations, cost effectiveness, and impact on quality of life for patients with MF.Keywords: cutaneous T-cell lymphoma, nitrogen mustard, skin-directed therapy, chlormethine, NM, CTCL
