Treatment Overview

Receiving a diagnosis of Mycosis Fungoides (MF), a rare type of skin lymphoma, can be highly unsettling. This chronic cancer of the immune system’s T-cells often first appears as itchy, stubborn patches or plaques that can be mistaken for eczema or psoriasis. Living with the fluctuating symptoms which can range from mild skin redness to painful tumors causes significant emotional and physical distress.

Treatment is essential for multiple reasons: to control the abnormal T-cell activity, clear skin lesions, manage intense itching, and prevent the disease from progressing to internal organs. Because MF is typically a slow-growing disease, the treatment plan is highly individualized and depends entirely on the stage of the disease, the extent of skin involvement, and the patient’s overall health. Treatment is often a continuous, long-term process aimed at achieving remission and maximizing quality of life (American Cancer Society, 2023).

Overview of treatment options for Mycosis Fungoides

The approach to treating Mycosis Fungoides is typically staged, starting with less intensive therapies for localized disease and progressing to systemic treatments for more advanced cases. The main goals are to clear the cancerous cells from the skin and prevent the disease from spreading.

For early-stage disease (Stage IA/IB), skin-directed therapies are the primary option. These include topical medications or phototherapy (light treatment). If the disease progresses to thicker plaques, tumors, or involves the blood, systemic (whole-body) medications become necessary. Medications used in both early and advanced stages primarily target the proliferation and survival of the malignant T-cells.

Medications used for Mycosis Fungoides

Medications for MF fall into distinct categories based on their delivery and mechanism:

  • Topical Agents (Early Stage): High-potency topical corticosteroids are often the first step, used to calm inflammation and reduce cell growth in patches. When these fail, topical chemotherapy agents, such as mechlorethamine, may be used.
  • Immunomodulators and Retinoids: For widespread or moderately advanced skin disease, medications that adjust the immune system are key. Interferon alpha, a biologic agent, is often given by injection to enhance the body’s anti-cancer response. Retinoids, such as bexarotene (an oral medication), are also used to encourage abnormal T-cells to mature and die.
  • Systemic Therapies (Advanced Stage): For more aggressive disease, newer oral or intravenous drugs, such as Histone Deacetylase (HDAC) inhibitors (vorinostat or romidepsin), are used. These target the genetic material of the cancer cells. Traditional chemotherapy drugs, such as low-dose methotrexate or gemcitabine, are generally reserved for when the disease is resistant to other treatments (National Cancer Institute, 2024).

How these medications work

The medications used for MF work by attacking the cancerous T-cells through different pathways.

Topical corticosteroids suppress the localized immune activity in the skin, reducing the inflammation and redness caused by the T-cells. Topical chemotherapy directly damages the DNA of the abnormal T-cells in the treated skin area, causing them to die.

Systemic drugs like HDAC inhibitors work inside the nucleus of the T-cells by altering how the cell’s DNA is packaged. This change makes the abnormal cells vulnerable, often forcing them to stop dividing and undergo programmed cell death. Immunomodulators like interferon alpha enhance the patient’s own immune system, boosting its ability to recognize and destroy the malignant T-cells. Clinical data suggests these combined approaches provide durable control over MF symptoms in many patients.

Side effects and safety considerations

All medications used for MF require careful monitoring. Topical treatments can cause localized side effects, including severe skin irritation, dryness, or, with long-term steroid use, thinning of the skin.

Systemic treatments have significant risks. Common side effects for HDAC inhibitors and chemotherapy include fatigue, nausea, vomiting, and suppressed blood counts (raising infection/anemia risk). Interferon alpha often causes temporary flu-like symptoms (fever, muscle aches). As many systemic drugs can harm a fetus, strict birth control is vital during treatment. Patients must seek immediate medical help for unexplained high fever, infection signs, or unusual bruising/bleeding (Mayo Clinic, 2022).

Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care.

References

  1. American Cancer Society. https://www.cancer.org
  2. Mayo Clinic. https://www.mayoclinic.org
  3. National Cancer Institute. https://www.cancer.gov
  4. National Institutes of Health. https://www.nih.gov

Medications for Mycosis Fungoides

These are drugs that have been approved by the US Food and Drug Administration (FDA), meaning they have been determined to be safe and effective for use in Mycosis Fungoides.

Found 7 Approved Drugs for Mycosis Fungoides

Adcetris

Generic Name
Brentuximab Vedotin

Adcetris

Generic Name
Brentuximab Vedotin
Form: Injection
Method of administration: Intravenous
FDA approval date: August 25, 2011
Classification: CD30-directed Immunoconjugate
ADCETRIS is a CD30-directed antibody and microtubule inhibitor conjugate indicated for treatment of: Adult patients with previously untreated Stage III or IV classical Hodgkin lymphoma (cHL), in combination with doxorubicin, vinblastine, and dacarbazine.

MethylPREDNISolone

Brand Names
Solu-Medrol MethylPREDNISolone, Solu-Medrol, Medrol

MethylPREDNISolone

Brand Names
Solu-Medrol MethylPREDNISolone, Solu-Medrol, Medrol
Form: Injection, Tablet
Method of administration: Oral, Intravenous, Intramuscular
FDA approval date: October 24, 1957
Classification: Corticosteroid
When oral therapy is not feasible, and the strength, dosage form, and route of administration of the drug reasonably lend the preparation to the treatment of the condition, the intravenous or intramuscular use of Methylprednisolone Sodium Succinate for Injection, USP, is indicated as follows: Allergic states Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, perennial or seasonal allergic rhinitis, serum sickness, transfusion reactions. Dermatologic diseases Bullous dermatitis herpetiformis, exfoliative erythroderma, mycosis fungoides, pemphigus, severe erythema multiforme (Stevens-Johnson syndrome). Endocrine disorders Primary or secondary adrenocortical insufficiency (hydrocortisone or cortisone is the drug of choice; synthetic analogs may be used in conjunction with mineralocorticoids where applicable; in infancy, mineralocorticoid supplementation is of particular importance), congenital adrenal hyperplasia, hypercalcemia associated with cancer, nonsuppurative thyroiditis. Gastrointestinal diseases To tide the patient over a critical period of the disease in regional enteritis (systemic therapy) and ulcerative colitis. Hematologic disorders Acquired (autoimmune) hemolytic anemia, congenital (erythroid) hypoplastic anemia (Diamond-Blackfan anemia), idiopathic thrombocytopenic purpura in adults (intravenous administration only; intramuscular administration is contraindicated), pure red cell aplasia, selected cases of secondary thrombocytopenia. Miscellaneous Trichinosis with neurologic or myocardial involvement, tuberculous meningitis with subarachnoid block or impending block when used concurrently with appropriate antituberculous chemotherapy. Neoplastic diseases For the palliative management of leukemias and lymphomas. Nervous System Acute exacerbations of multiple sclerosis; cerebral edema associated with primary or metastatic brain tumor, or craniotomy. Ophthalmic diseases Sympathetic ophthalmia, uveitis and ocular inflammatory conditions unresponsive to topical corticosteroids. Renal diseases To induce diuresis or remission of proteinuria in idiopathic nephrotic syndrome or that due to lupus erythematosus. Respiratory diseases Berylliosis, fulminating or disseminated pulmonary tuberculosis when used concurrently with appropriate antituberculous chemotherapy, idiopathic eosinophilic pneumonias, symptomatic sarcoidosis. Rheumatic disorders As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis; acute rheumatic carditis; ankylosing spondylitis; psoriatic arthritis; rheumatoid arthritis, including juvenile rheumatoid arthritis (selected cases may require low-dose maintenance therapy). For the treatment of dermatomyositis, temporal arteritis, polymyositis, and systemic lupus erythematosus.

Poteligeo

Generic Name
Mogamulizumab-Kpkc

Poteligeo

Generic Name
Mogamulizumab-Kpkc
Form: Injection
Method of administration: Intravenous
FDA approval date: August 08, 2018
Classification: Chemokine Receptor Type 4 Interaction
POTELIGEO is indicated for the treatment of adult patients with relapsed or refractory mycosis fungoides (MF) or Sézary syndrome (SS) after at least one prior systemic therapy. POTELIGEO is a CC chemokine receptor type 4 (CCR4)-directed monoclonal antibody indicated for the treatment of adult patients with relapsed or refractory mycosis fungoides or Sézary syndrome after at least one prior systemic therapy ( 1 ).

Kenalog

Brand Names
Lidolog, Mlk F3, Mlk F1, Pro-C-Dure 6, Bupivilog

Kenalog

Brand Names
Lidolog, Mlk F3, Mlk F1, Pro-C-Dure 6, Bupivilog
Form: Kit
Method of administration: Intra-articular, Epidural, Topical, Intramuscular, Infiltration
FDA approval date: January 16, 2014
Intramuscular Where oral therapy is not feasible, injectable corticosteroid therapy, including triamcinolone acetonide injectable suspension is indicated for intramuscular use as follows: Allergic states: Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, perennial or seasonal allergic rhinitis, serum sickness, transfusion reactions. Dermatologic diseases: Bullous dermatitis herpetiformis, exfoliative erythroderma, mycosis fungoides, pemphigus, severe erythema multiforme (Stevens-Johnson syndrome). Endocrine disorders: Primary or secondary adrenocortical insufficiency (hydrocortisone or cortisone is the drug of choice; synthetic analogs may be used in conjunction with mineralocorticoids where applicable; in infancy, mineralocorticoid supplementation is of particular importance), congenital adrenal hyperplasia, hypercalcemia associated with cancer, nonsuppurative thyroiditis. Gastrointestinal diseases: To tide the patient over a critical period of the disease in regional enteritis and ulcerative colitis. Hematologic disorders: Acquired (autoimmune) hemolytic anemia, Diamond-Blackfan anemia, pure red cell aplasia, selected cases of secondary thrombocytopenia. Miscellaneous: Trichinosis with neurologic or myocardial involvement, tuberculous meningitis with subarachnoid block or impending block when used with appropriate antituberculous chemotherapy. Neoplastic diseases: For the palliative management of leukemias and lymphomas. Nervous system: Acute exacerbations of multiple sclerosis; cerebral edema associated with primary or metastatic brain tumor or craniotomy. Ophthalmic diseases: Sympathetic ophthalmia, temporal arteritis, uveitis and ocular inflammatory conditions unresponsive to topical corticosteroids. Renal diseases: To induce diuresis or remission of proteinuria in idiopathic nephrotic syndrome or that due to lupus erythematosus. Respiratory diseases: Berylliosis, fulminating or disseminated pulmonary tuberculosis when used concurrently with appropriate antituberculous chemotherapy, idiopathic eosinophilic pneumonias, symptomatic sarcoidosis. Rheumatic disorders: As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis; acute rheumatic carditis; ankylosing spondylitis; psoriatic arthritis; rheumatoid arthritis, including juvenile rheumatoid arthritis (selected cases may require low-dose maintenance therapy). For the treatment of dermatomyositis, polymyositis and systemic lupus erythematosus. Intra-Articular The intra-articular or soft tissue administration of triamcinolone acetonide injectable suspension is indicated as adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, synovitis of osteoarthritis.

Solu-Cortef

Generic Name
Solu-Cortef

Solu-Cortef

Generic Name
Solu-Cortef
Form: Injection
Method of administration: Intravenous, Intramuscular
FDA approval date: April 27, 1955
Classification: Corticosteroid
When oral therapy is not feasible, and the strength, dosage form, and route of administration of the drug reasonably lend the preparation to the treatment of the condition, the intravenous or intramuscular use of hydrocortisone sodium succinate for injection is indicated as follows: Allergic states: Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, serum sickness, transfusion reactions. Dermatologic diseases: Bullous dermatitis herpetiformis, exfoliative erythroderma, mycosis fungoides, pemphigus, severe erythema multiforme (Stevens-Johnson syndrome). Endocrine disorders: Primary or secondary adrenocortical insufficiency (hydrocortisone or cortisone is the drug of choice; synthetic analogs may be used in conjunction with mineralocorticoids where applicable; in infancy, mineralocorticoid supplementation is of particular importance), congenital adrenal hyperplasia, hypercalcemia associated with cancer, nonsuppurative thyroiditis. Gastrointestinal diseases: To tide the patient over a critical period of the disease in regional enteritis (systemic therapy) and ulcerative colitis. Hematologic disorders: Acquired (autoimmune) hemolytic anemia, congenital (erythroid) hypoplastic anemia (Diamond Blackfan anemia), idiopathic thrombocytopenic purpura in adults (intravenous administration only; intramuscular administration is contraindicated), pure red cell aplasia, select cases of secondary thrombocytopenia. Miscellaneous: Trichinosis with neurologic or myocardial involvement, tuberculous meningitis with subarachnoid block or impending block when used concurrently with appropriate antituberculous chemotherapy. Neoplastic diseases: For the palliative management of leukemias and lymphomas. Nervous System: Cerebral edema associated with primary or metastatic brain tumor, or craniotomy. Ophthalmic diseases: Sympathetic ophthalmia, uveitis and ocular inflammatory conditions unresponsive to topical corticosteroids. Renal diseases: To induce diuresis or remission of proteinuria in idiopathic nephrotic syndrome, or that due to lupus erythematosus. Respiratory diseases: Berylliosis, fulminating or disseminated pulmonary tuberculosis when used concurrently with appropriate antituberculous chemotherapy, idiopathic eosinophilic pneumonias, symptomatic sarcoidosis. Rheumatic disorders: As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis; acute rheumatic carditis; ankylosing spondylitis; psoriatic arthritis; rheumatoid arthritis, including juvenile rheumatoid arthritis (selected cases may require low-dose maintenance therapy). For the treatment of dermatomyositis, temporal arteritis, polymyositis, and systemic lupus erythematosus.
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