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Avallone G, Roccuzzo G, Pileri A, Agostinelli C, Maronese CA, Aquino C, Tavoletti G, Onida F, Fava P, Ribero S, Marzano AV, Berti E, Quaglino P, Alberti-Violetti S. Clinicopathological definition, management and prognostic value of mogamulizumab-associated rash and other cutaneous events: A systematic review. J Eur Acad Dermatol Venereol 2024; 38:1738-1748. [PMID: 38279614 DOI: 10.1111/jdv.19801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/06/2023] [Indexed: 01/28/2024]
Abstract
Mogamulizumab is a first-in-class IgG1k monoclonal antibody that selectively targets the chemokine receptor type 4. The drug has received Food and Drug administration authorisation for mycosis fungoides and Sézary syndrome following failure of at least one previous course of systemic therapy and now is available in Europe. One of the most common treatment-related side effects observed has been the mogamulizumab-associated rash (MAR), which affects up to a quarter of patients and is the most frequent adverse event leading to drug discontinuation. The aim of this study is to perform a systematic review of the literature on patients diagnosed with MAR and other mogamulizumab-related cutaneous events to describe the clinical and histological characteristics, the management in clinical practice and to assess whether these events have prognostic implications. In total, 2073 records were initially identified through a literature search, 843 of which were duplicates. After screening for eligibility and inclusion criteria, 49 articles reporting mogamulizumab-associated cutaneous events were included. Totally, 1516 patients were retrieved, with a slight male prevalence as for the available data (639 males and 570 females, i.e. 52.9% vs. 47.1%). Regarding the reported clinicopathological findings of the cutaneous reactions, the five most common patterns were spongiotic/psoriasiform dermatitis (22%), eruptions characterized by the presence of papules and/or plaques (16.1%), cutaneous granulomatosis (11.4%), morbilliform or erythrodermic dermatitis (9.4%) and photodermatitis (7.1%). Our results highlight how the majority of the reported cutaneous adverse events on mogamulizumab are of mild-to-moderate entity and generally manageable in clinical practice, though prompt recognition is essential and case-by-case assessment should be recommended. Future research will need to focus on the MAR prognostic implications and to identify genomic and molecular markers for a more rapid and accurate diagnosis.
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Affiliation(s)
- G Avallone
- Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - G Roccuzzo
- Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
| | - A Pileri
- Dermatology Unit, IRCCS of Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - C Agostinelli
- Hematopathology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - C A Maronese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - C Aquino
- Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
| | - G Tavoletti
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - F Onida
- Hematology-BMT Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - P Fava
- Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
| | - S Ribero
- Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - E Berti
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Inter-Hospital Pathology Division, IRCCS MultiMedica, Milan, Italy
| | - P Quaglino
- Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
| | - S Alberti-Violetti
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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Zengarini C, Guglielmo A, Mussi M, Motta G, Agostinelli C, Sabattini E, Piraccini BM, Pileri A. A Narrative Review of the State of the Art of CCR4-Based Therapies in Cutaneous T-Cell Lymphomas: Focus on Mogamulizumab and Future Treatments. Antibodies (Basel) 2024; 13:32. [PMID: 38804300 PMCID: PMC11130839 DOI: 10.3390/antib13020032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/03/2024] [Accepted: 04/16/2024] [Indexed: 05/29/2024] Open
Abstract
The CCR4 receptor is a pivotal target in cutaneous T-cell lymphoma (CTCL) therapy due to its role in impairing immune responses against malignant T-cells and expression profiles. Monoclonal antibodies like mogamulizumab effectively bind to CCR4, reducing tumour burden and enhancing patient outcomes by inhibiting the receptor's interaction with ligands, thereby hindering malignant T-cell migration and survival. Combining CCR4 antibodies with chemotherapy, radiation, and other drugs is being explored for synergistic effects. Additionally, small-molecular inhibitors, old pharmacological agents interacting with CCR4, and CAR-T therapies are under investigation. Challenges include drug resistance, off-target effects, and patient selection, addressed through ongoing trials refining protocols and identifying biomarkers. Despite advancements, real-life data for most of the emerging treatments are needed to temper expectations. In conclusion, CCR4-targeted therapies show promise for CTCL management, but challenges persist. Continued research aims to optimise treatments, enhance outcomes, and transform CTCL management. This review aims to elucidate the biological rationale and the several agents under various stages of development and clinical evaluation with the actual known data.
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Affiliation(s)
- Corrado Zengarini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (C.Z.)
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alba Guglielmo
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Institute of Dermatology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Martina Mussi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (C.Z.)
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Giovanna Motta
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (C.Z.)
- Division of Haematopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Claudio Agostinelli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (C.Z.)
- Division of Haematopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Elena Sabattini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (C.Z.)
- Division of Haematopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Bianca Maria Piraccini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (C.Z.)
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alessandro Pileri
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (C.Z.)
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Fernández-Guarino M, Ortiz P, Gallardo F, Llamas-Velasco M. Clinical and Real-World Effectiveness of Mogamulizumab: A Narrative Review. Int J Mol Sci 2024; 25:2203. [PMID: 38396877 PMCID: PMC10889597 DOI: 10.3390/ijms25042203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/05/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Mogamulizumab (MOG) is an antibody targeting the CCR4 receptor, authorized for relapsed or refractory peripheral T-cell (PTCL) and cutaneous T-cell lymphomas (CTCL). Its adoption in guidelines and endorsement by FDA and EMA established it as a systemic treatment, especially for advanced disease stages due to its comparatively lower toxicity. Clinical trials and real-world evidence have underscored its efficacy in advanced CTCLs, including mycosis fungoides and Sézary syndrome; PTCLs; and adult T-cell leukemia/lymphoma (ATLL), showcasing positive outcomes. Notably, the drug has demonstrated significant response rates, disease stability, and extended periods of progression-free survival, suggesting its applicability in cases with multiple treatment lines. Its safety profile is generally manageable, with adverse events (AEs) primarily related to the skin, infusion-related reactions, drug eruptions, autoimmune diseases, and skin disorders. The latter seem to appear as CCR4 can promote the skin-specific homing of lymphocytes, and MOG is directed against this receptor. While combination with immunostimulatory agents like interferon alpha and interleukin 12 has shown promising results, caution is urged when combining with PD1 inhibitors due to the heightened risk of immune-mediated AEs. The introduction of MOG as a systemic treatment implies a significant advancement in managing these diseases, supported by its favorable safety profile and complementary mechanisms.
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Affiliation(s)
- Montserrat Fernández-Guarino
- Dermatology Department, Hospital Universitario Ramón y Cajal, Instituto de Investigación Sanitaria Ramón y Cajal (Irycis), 28034 Madrid, Spain;
| | - Pablo Ortiz
- Dermatology Department, Hospital 12 de Octubre, 28041 Madrid, Spain;
| | | | - Mar Llamas-Velasco
- Dermatology Department, Hospital Universitario de la Princesa, Fundación de Investigación Biomédica de la Princesa, 28006 Madrid, Spain
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Sonego B, Ibatici A, Rivoli G, Angelucci E, Sola S, Massone C. Histopathological Markers for Target Therapies in Primary Cutaneous Lymphomas. Cells 2023; 12:2656. [PMID: 37998391 PMCID: PMC10670482 DOI: 10.3390/cells12222656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/09/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023] Open
Abstract
In recent years, targeted (biological) therapies have become available also for primary cutaneous T-cell lymphomas (PCTCLs) including anti-CD30 (brentuximab vedotin) in mycosis fungoides, primary cutaneous anaplastic large T-cell lymphoma, lymphomatoid papulosis; anti-CCR4 (mogamulizumab) in Sezary syndrome; anti-CD123 (tagraxofusp) in blastic plasmocytoid cell neoplasm. Moreover, anti-PD1 (nivolumab), anti-PDL1 (pembrolizumab, atezolizumab), anti-CD52 (alemtuzumab), anti-KIR3DL2-CD158k (lacutamab), and anti-CD70 (cusatuzumab) have been tested or are under investigations in phase II trials. The expression of these epitopes on neoplastic cells in skin biopsies or blood samples plays a central role in the management of PCTCL patients. This narrative review aims to provide readers with an update on the latest advances in the newest therapeutic options for PCTCLs.
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Affiliation(s)
- Benedetta Sonego
- Dermatology Clinic, University of Trieste, 35125 Trieste, Italy;
| | - Adalberto Ibatici
- UO Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (A.I.); (G.R.); (E.A.)
| | - Giulia Rivoli
- UO Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (A.I.); (G.R.); (E.A.)
| | - Emanuele Angelucci
- UO Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (A.I.); (G.R.); (E.A.)
| | - Simona Sola
- Surgical Pathology, Galliera Hospital, 16128 Genoa, Italy;
| | - Cesare Massone
- Dermatology Unit & Scientific Directorate, Galliera Hospital, 16128 Genoa, Italy
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Gosmann J, Bielefeld A, Schmitz FJ, Schaper-Gerhardt K, Gutzmer R, Stadler R. Die Wirkung von Mogamulizumab auf die aberrante T-Zell-Population im peripheren Blut - eine monozentrische retrospektive Analyse. J Dtsch Dermatol Ges 2023; 21:992-1002. [PMID: 37700404 DOI: 10.1111/ddg.15144_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 05/07/2023] [Indexed: 09/14/2023]
Abstract
ZusammenfassungHintergrundDie Wirkung von Mogamulizumab bei kutanen T‐Zell‐Lymphomen (CTCL) auf die T‐Zellen (TZ) im peripheren Blut und deren potenzielle Rolle bei der Steuerung von Behandlungsintervallen wird noch erforscht.MethodikWir untersuchten in einer retrospektiven monozentrischen Analyse die Wirkung von Mogamulizumab auf die CD3+ TZ und die aberrante T‐Zellpopulation (TZP), CD4+/CD7– und die CD4+/CD26– TZ, die mittels Durchflusszytometrie analysiert wurden.ErgebnisseDreizehn Patienten mit CTCL wurden eingeschlossen. Nach vier Zyklen kam es zu einer durchschnittlichen Reduktion der CD3+ TZ um 57%, der CD4+/CD7− um 72% und der CD4+/CD26− TZ um 75% im Vergleich zum individuellen Ausgangswert eines jeden Patienten. Die Reduktionen der CD4+/CD7+ und CD4+/CD26+ TZ fielen mit durchschnittlich 54% und 41% geringer aus. Ein signifikanter Rückgang der aberranten TZP war bereits nach der ersten Infusion zu beobachten. Ein medianes Plateau der TZP trat bereits während der Induktionsphase ein. Bei 5/13 Patienten kam es zu einem Progress der Erkrankung, ohne dass eine eindeutige Korrelation mit der aberranten TZP bestand.SchlussfolgerungenBereits nach einer Gabe Mogamulizumab reduzierte sich die aberrante TZP und – in geringerem Maße – die normale TZP. Wir konnten keine eindeutige Korrelation der TZP mit der Wirksamkeit von Mogamulizumab beobachten. Es werden weitere Untersuchungen mit einer größeren Anzahl von Patienten benötigt.
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Affiliation(s)
- Janika Gosmann
- Universitätsklinik für Dermatologie, Venerologie, Allergologie und Phlebologie, Hauttumorzentrum, Johannes Wesling Klinikum Minden, Ruhr-Universität Bochum, Minden
| | - Annette Bielefeld
- Institut für Laboratoriumsmedizin, Mikrobiologie, Umweltmedizin und Transfusionsmedizin, Johannes Wesling Klinikum Minden, Ruhr-Universität Bochum, Minden
| | - Franz-Josef Schmitz
- Institut für Laboratoriumsmedizin, Mikrobiologie, Umweltmedizin und Transfusionsmedizin, Johannes Wesling Klinikum Minden, Ruhr-Universität Bochum, Minden
| | - Katrin Schaper-Gerhardt
- Universitätsklinik für Dermatologie, Venerologie, Allergologie und Phlebologie, Hauttumorzentrum, Johannes Wesling Klinikum Minden, Ruhr-Universität Bochum, Minden
- Klinik für Dermatologie, Allergologie und Venerologie, Hauttumorzentrum Hannover (HTZH), Medizinische Hochschule Hannover
| | - Ralf Gutzmer
- Universitätsklinik für Dermatologie, Venerologie, Allergologie und Phlebologie, Hauttumorzentrum, Johannes Wesling Klinikum Minden, Ruhr-Universität Bochum, Minden
| | - Rudolf Stadler
- Universitätsklinik für Dermatologie, Venerologie, Allergologie und Phlebologie, Hauttumorzentrum, Johannes Wesling Klinikum Minden, Ruhr-Universität Bochum, Minden
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Gosmann J, Bielefeld A, Schmitz FJ, Schaper-Gerhardt K, Gutzmer R, Stadler R. The effect of mogamulizumab on the aberrant T cell population in the peripheral blood - A monocentric retrospective analysis. J Dtsch Dermatol Ges 2023; 21:992-1002. [PMID: 37401138 DOI: 10.1111/ddg.15144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 05/07/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND AND OBJECTIVES The effect of mogamulizumab in cutaneous T-cell lymphoma (CTCL) on T cells (TC) in the peripheral blood and its potential role to navigate treatment intervals are explored. METHODS We investigated within a retrospective monocentric analysis the effect of mogamulizumab on the CD3+ TC and the aberrant T cell population (TCP), i.e., the CD4+ /CD7- and the CD4+ /CD26- TC, analyzed by flow cytometry. RESULTS Thirteen patients with CTCL were included. After four cycles there was a mean reduction of 57% in CD3+ TC, 72% in the CD4+ /CD7- and 75% in the CD4+ /CD26- TCP compared to the individual baseline of each patient. The reduction in CD4+ /CD7+ and CD4+ /CD26+ TC was lower, averaging 54% and 41%. A significant decrease in aberrant TCP was already evident after the first administration. A median plateau of TCP already occurred during the IP. Progressive disease occurred in 5/13 patients without a clear correlation to aberrant TCP. CONCLUSIONS Already after one dose of mogamulizumab, aberrant TCP and, to a lesser extent, normal TC decrease. We did not observe a clear correlation between TCP and the efficacy of mogamulizumab, but further studies with larger numbers of patients are needed.
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Affiliation(s)
- Janika Gosmann
- University Department for Dermatology, Venereology, Allergology and Phlebology, Skin Cancer Center, Johannes Wesling Medical Center Minden, Ruhr University Bochum, Minden, Germany
| | - Annette Bielefeld
- Institute for laboratory medicine, microbiology, environmental medicine and transfusion medicine, Johannes Wesling Medical Center Minden, Ruhr University Bochum, Minden, Germany
| | - Franz-Josef Schmitz
- Institute for laboratory medicine, microbiology, environmental medicine and transfusion medicine, Johannes Wesling Medical Center Minden, Ruhr University Bochum, Minden, Germany
| | - Katrin Schaper-Gerhardt
- University Department for Dermatology, Venereology, Allergology and Phlebology, Skin Cancer Center, Johannes Wesling Medical Center Minden, Ruhr University Bochum, Minden, Germany
- Department of Dermatology, Allergology and Venereology, Hannover Skin Cancer Center (HTZH), Hannover Medical School, Hannover, Germany
| | - Ralf Gutzmer
- University Department for Dermatology, Venereology, Allergology and Phlebology, Skin Cancer Center, Johannes Wesling Medical Center Minden, Ruhr University Bochum, Minden, Germany
| | - Rudolf Stadler
- University Department for Dermatology, Venereology, Allergology and Phlebology, Skin Cancer Center, Johannes Wesling Medical Center Minden, Ruhr University Bochum, Minden, Germany
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