Monitoring Response in Early-Stage Mycosis Fungoides & Importance of Patient Education

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Advanced stage CTCL treatment requires careful consideration of disease location and specific therapeutic targets, with recent large-scale studies providing evidence-based guidance for agent selection. Brentuximab vedotin, an anti-CD30 antibody-drug conjugate, demonstrates particular efficacy in patients with bulky lymph node disease or large cell transformation, though data in Sézary syndrome remains limited due to exclusion from the pivotal ALCANZA study. The chronic nature of CTCL necessitates long-term treatment tolerance considerations.

Peripheral neuropathy represents the primary dose-limiting toxicity of brentuximab vedotin, requiring proactive monitoring and potential dose modifications to enable prolonged treatment duration. Clinicians should employ objective neuropathy assessments including gait evaluation and fine motor function testing, as patients may underreport symptoms to continue effective therapy. Dose reduction strategies can extend treatment duration while maintaining efficacy, aligning with the chronic disease management principles essential in CTCL care.

Mogamulizumab, a CCR4-targeted monoclonal antibody, shows preferential activity in patients with significant peripheral blood involvement characteristic of Sézary syndrome, but demonstrates limited efficacy in lymph node disease. This compartment-specific activity pattern emphasizes the importance of accurate disease staging and anatomic involvement assessment in treatment selection. Advanced stage patients benefit from continued skin-directed therapies alongside systemic treatments, requiring ongoing patient education about treatment expectations, potential toxicities, and the chronic nature of their disease management journey.