Therapeutic targets
- Symptomatic therapy
- Remission (regression)
- Improvement in the quality of life
Therapy recommendations
Therapy for mycosis fungoides is stage-dependent.
- Stage 1 and 2:
- Local therapy:
- Topical glucocorticoids (class III and IV) in the form of ointments or creams.
- Retinoids: bexarotene – specifically designed to treat mycosis fungoides; induces apoptosis (programmed cell death) of tumor cells
- In March 2017, the drug Legada was approved. It contains the active ingredient chlormethine and is applied as a gel thinly once a day to the affected skin areas. Chloromethine prevents cell division.
- Physical therapy (see under “Other therapy”):
- PUVA therapy, i.e. combined use of UVA light (UV-A phototherapy) and psoralen.
- Extracorporeal photopheresis (ECP) – apheresis (“blood washing”), in which certain blood cells are subjected to treatment with ultraviolet light (phototherapy) outside the body (extracorporeal).
- Local radiotherapy with X-rays or electron beams.
- From stage 2 combined treatment with interferon α in the form of injections (immunotherapy) and PUVA; alternatively, methotrexate may be used.
- Local therapy:
- Stage 3 and 4:
- Therapy with monoclonal antibodies (mogamulizumab; brentuximab vedotin).
- Additional palliative chemotherapy (polychemotherapy/CHOP regimen) or radiotherapy → symptom-relieving.
Further notes
- Because CCR4 is overexpressed in mycosis fungoides regardless of stage, this receptor was identified as a relevant therapeutic target and the anti-CCR4 antibody mogamulizumab was developed. This resulted in more than twice the median progression-free survival (primary study endpoint) (7.7 versus 3.1 months) in patients with relapsed or refractory mycosis fungoides in the pivotal study compared with vorinostat.
