Advances in the pharmacological management of cutaneous T-cell lymphoma

ABSTRACT

Introduction

Current treatment guidelines for cutaneous T cell lymphoma (CTCL) advocate a stage-driven approach, considering clinical presentation, symptom burden, and patient comorbidities. Therapy selection hinges on factors like disease subtype, severity, and treatment availability. The primary goal is to enhance the quality of life by mitigating symptoms, as achieving lasting complete remission is infrequent.

Areas covered

Over the past decade (2013–2023), the therapeutic landscape of CTCL has experienced substantial transformation with the introduction of innovative therapies. This review explores the main pivotal developments in traditional treatment schedules and recently introduced drugs, aiming to offer clinicians and researchers a thorough perspective on the decade’s progress in the field.

Expert opinion

Despite the progress made in CTCL therapeutics, ranging from topical chemotherapeutics to immunomodulatory agents, several unmet needs persist. Firstly, there is a pressing need for the incorporation of readily available predictors for treatment response, encompassing clinical, pathological, and molecular features. Secondly, a more profound comprehension of the tumor microenvironment is imperative to optimize the landscape of targetable molecules. Lastly, the undertaking of studies on combination regimens should be encouraged as it enhances therapy efficacies by synergistically combining agents with diverse modes of action.

KEYWORDS:

• Cutaneous lymphoma
• CTCL
• mycosis fungoides
• Sèzary syndrome
• mogamulizumab
• brentuximab
• lacutamab
• TSEBT

Article highlights

• Treatment for CTCL involves a multidisciplinary approach aiming at symptom control and maintaining quality of life.

• Skin-directed therapies include chlormethine gel alongside phototherapy, a historical treatment for early-stage MF, and radiation therapy, with low-dose TSEBT offering positive results.

• Systemic therapies feature Pegylated IFN-α 2a replacing older forms of IFN-α, retinoids demonstrating efficacy particularly in combination treatments, and chemotherapy-based regimens.

• Immunomodulatory agents like brentuximab vedotin, mogamulizumab, and lacutamab have reshaped the treatment landscape.

• Ongoing research focuses on new topical and systemic therapies, including PD-1/PD-L1 axis inhibitors and combination regimens.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer on this manuscript has disclosed being on the Advisory Board of Kyowa Kirin. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.