Immune-related adverse events associated with Mogamulizumab: a comprehensive review of the literature

ABSTRACT

Introduction

Mogamulizumab is an anti-C-C chemokine receptor 4 antibody that is increasingly being used to treat T-cell malignancies such as cutaneous T-cell lymphoma, adult T-cell leukemia-lymphoma, and peripheral T-cell lymphoma. Because CCR4 is expressed on both malignant T-cells and regulatory T-cells (Tregs), mogamulizumab can be associated with increased immune-related adverse events (irAEs). While there is abundant literature on mogamulizumab-associated rash (MAR) and graft-versus-host disease (GVHD), other reported irAEs have not been collated into a single review.

Areas Covered

This narrative review covers irAEs associated with mogamulizumab in patients with T-cell lymphomas, focusing on events other than MAR and GVHD. We searched PubMed and Google Scholar for case reports, case series, chart reviews, and clinical trials published from inception to March 2024. Identified events include alopecia, vitiligo, arthritis, psoriasis, myocarditis, myositis/polymyositis, hepatitis, and others.

Expert Opinion

Mogamulizumab’s ability to augment the host immune response through Treg depletion adds to its efficacy but has wide-ranging implications for autoimmunity across multiple organ systems, similar to immune checkpoint inhibitor therapy. Occurrence of irAEs may be associated with improved overall clinical response, although long-term follow-up studies are needed.

KEYWORDS:

• Adverse events
• CTCL
• cutaneous oncology
• mogamulizumab
• T-cell lymphoma

Disclaimer

As a service to authors and researchers we are providing this version of an accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proofs will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to these versions also.

Article Highlights

-	Mogamulizumab is a CCR4 antibody used to treat T-cell lymphomas, including CTCL, ATLL, and PTCL.
-	Mogamulizumab has been associated with a wide range of immune-related adverse events (irAEs), beyond the frequently reported AEs of MAR & GVHD.
-	These irAEs are often associated with improved disease response, although rarely they can lead to poor outcomes (such as in the cases of myocarditis). Long-term follow-up studies are needed to assess the natural history of mogamulizumab-associated irAEs and their prognostic implications.

Declaration of Interests

SK Barta serves on the advisory board and/or provides consultation to the following companies: Acrotech, BMS, Daiichi Sankyo, and Kyowa Kirin. He has also given non-CME lectures for Acrotech and Kyowa Kirin and serves on the data safety and monitoring board for Janssen. The other 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

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Table 1. Summary of Immune-related Adverse Events

Additional information

Funding

This paper was not funded.