Expert opinions and clinical experiences with chlormethine gel as maintenance treatment for patients with mycosis fungoides.

Maintenance treatment can be recommended for patients with mycosis fungoides (MF) whose disease responds to primary treatment. While positive outcomes have been observed in small studies with maintenance therapy, there is a lack of practical guidelines and agreement on when and how maintenance therapy for MF should be approached. In this article, we discuss expert opinions and clinical experiences on the topic of maintenance therapy for patients with MF, with a focus on chlormethine gel. Ideally, patients should have a durable response before initiating maintenance therapy. The definition of and required duration of durable response are topics that are open to debate and currently have no consensus. Chlormethine gel has several attributes that make it suitable for maintenance therapy; it can be easily applied at home, can be combined with other treatment options for maintenance, and has a manageable safety profile. Chlormethine gel as maintenance therapy can be applied at decreasing frequencies after active treatment with chlormethine gel or other therapies until the minimally effective dose is reached. Patients generally tend to adhere well to chlormethine gel maintenance regimens and may remain on treatment for several years. The experiences described here may be useful for clinicians when deciding on maintenance treatment regimens for their patients. Development of guidelines based on clinical trial outcomes will be important to ensure the most effective maintenance treatment strategies are used for patients with MF.

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Copyright © 2024 Geskin, Querfeld, Hodak, Nikbakht, Papadavid, Ardigò, Wehkamp and Bagot.

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LG: consulting fees, payment or honoraria, and/or research grant support: Helsinn, Kyowa Kirin, Mallinckrodt Pharmaceuticals, Recordati Rare Diseases, Regeneron, Sanofi, Merck and Soligenix, UpToDate, and Medscape; patent on method to diagnose cutaneous lymphoma; leadership role: International Society for Cutaneous Lymphomas and United States Cutaneous Lymphoma Consortium; stock/stock options: CelSyntec, Inc. NN: advisory board: Helsinn and Kyowa Kirin. CQ: steering committee/advisory board: Helsinn, Kyowa Kirin; Investigator: Helsinn, Celgene (Bristol Myers Squibb), Kyowa Kirin; Research Grants: Celgene, Helsinn. EH: scientific advisory board: Actelion, Helsinn, Recordati Rare Diseases, Takeda; speakers’ bureau: Helsinn, Rafa, Takeda. EP: lecturer: Helsinn, Mallinckrodt, AbbVie, Janssen, Novartis. MA: lecturer: Helsinn, Kyowa Kirin, Takeda, VivaScope, Almirall, Recordati Rare Diseases. UW: clinical investigator: miRagen, Kyowa Kirin, Innate Pharma, 4SC; honoraria for lectures/advisory boards: Helsinn, Kyowa Kirin, MSD, Takeda, Mundipharma, Galderma, Stemline. MB: advisory board: Helsinn-Recordati, Kyowa Kirin, Takeda, Innate Pharma. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision. The authors declare that this study received funding for editorial and medical writing assistance from Helsinn Healthcare SA. Helsinn Healthcare SA had the following involvement in the study: review of the manuscript.