mogamulizumab for previously treated mycosis fungoides and Sezary syndrome

Last edited 12/2021 and last reviewed 01/2022

Cutaneous T-cell lymphoma (CTCL) is a rare non-Hodgkin lymphoma (NHL) that primarily arises in the skin but may involve the viscera, lymphatic system

• mycosis fungoides is the most common subtype of CTCL

NICE state (1):

• Mogamulizumab is recommended, within its marketing authorisation, as an option for treating Sezary syndrome (SS) in adults who have had at least 1 systemic treatment
• Mogamulizumab is recommended as an option for treating mycosis fungoides (MF) in adults, only if:
  • their condition is stage 2B or above and
  • they have had at least 2 systemic treatments

Notes (2,3):

• MF is the most common subtype of CTCL, with 1,620 incidences reported in 2016 in the United States, and is often characterized by patches, plaques, and erythroderma. SS is a much more rare and aggressive leukemic variant of CTCL, with an incidence of 70 in the same year (3)
• study evidence evaluated mogamulizumab (a novel CCR4 humanized monoclonal antibody) , in relapsed/refractory MF and SS, show a meaningful progression free survival (PFS) benefit
• the Phase III MAVORIC study compared mogamulizumab to vorinostat, an FDA approved drug for this indication, in 372 patients
  • mogamulizumab was found to have a superior PFS with a median of 7.7 months compared to 3.1 months in the vorinostat arm, with a hazard ratio of 0.53, p<0.001
  • mogamulizumab was well tolerated with the most common AE being infusion-related reactions (32%), drug rash (20%), diarrhea (23%), and fatigue (22%)
• use of mogamulizumab up to 50 days prior to allogeneic hematopoietic stem cell transplantation has been associated with an increased risk of severe acute graft-vs.-host disease, steroid-refractory graft-vs.-host disease, and mortality (3)

Reference:

• NICE (December 2021). Mogamulizumab for previously treated mycosis fungoides and Sezary syndrome
• Blackmon AL, Pinter-Brown L. Spotlight on Mogamulizumab-Kpkc for Use in Adults with Relapsed or Refractory Mycosis Fungoides or Sézary Syndrome: Efficacy, Safety, and Patient Selection. Drug Des Devel Ther. 2020;14:3747-3754. Published 2020 Sep 16. doi:10.2147/DDDT.S185896
• Watson S, Marx JB. Mogamulizumab-kpkc: A Novel Therapy for the Treatment of Cutaneous T-Cell Lymphoma. J Adv Pract Oncol. 2019;10(8):883-888. doi:10.6004/jadpro.2019.10.8.10