Treatment-related skin disorders were noted in 51% of patients. Cutaneous adverse reactions to mogamulizumab in adult T-cell leukemia/lymphoma appear to be associated with more favorable prognosis—possibly related to reductions in T-reg cell populations.3,6 In some adult patients with T-cell leukemia/lymphoma, mogamulizumab is associated with onset of Stevens-Johnson Syndrome.7

The authors reported no treatment-related deaths.

“Mogamulizumab exhibited clinical meaningful antitumor activity in patients with relapsed PTCL and CTCL, with an acceptable toxicity profile,” the authors reported, noting that survival outcomes were comparable with those seen among patients taking mogamulizumab for adult T-cell leukemia/lymphomas.3 “It is notable that all three patients who relapsed after auto-peripheral blood stem-cell transplantation responded to mogamulizumab. The total ORR is comparable to that of other US Food and Drug Administration-approved drugs, such as pralatrexate and romidepsin.”


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But whereas the studies leading to FDA approval of pralatrexate and romidepsin included patients with relapsed and refractory disease, the new study exclusively enrolled patients with CCR4-positive relapse, which is associated with a poorer prognosis.3

“Given its novel mechanism of action and favorable toxicity profile compared with multiagent cytotoxic chemotherapy, we might expect the use of mogamulizumab in combination with other agents,” the authors reported.3

Bertrand Coiffier, MD, of the Hospices Civils de Lyon in Lyon, France, cautions that “very few patients benefit from this drug alone” but that its hematologic toxicities might well make mogamulizumab “difficult to combine with other drugs.”

“For me the efficacy is present but short, with hematologic toxicity,” Dr. Coiffier told ChemotherapyAdvisor.com. “The safety/efficacy ratio of mogamulizumab, as presented in this study, is unfavorable.”

The ORR of 35% is “honorable”, but similar to that offered by other drugs, with a low complete response rate (14%), noted Dr. Coiffier, an authority on PTCL.

No complete responses were seen among the study participants who had CTCL, Dr. Coiffier added.

References

  1. Lunning MA, Moskowitz AJ, Horwitz S. Strategies for relapsed peripheral T-cell lymphoma: the tail that wags the curve. J Clin Oncol. 2013;31(16):1922-1927.
  2. Reddy NM, Savani BN. Management of T-cell lymphomas: overcoming challenges and choosing the best treatment. Semin Hematol. 2014;51(1):1-4.
  3. Ogura M, Ishida T, Hatake K, et al. Multicenter phase II study of mogamulizumab (KW-0761), a defucosylated anti-cc chemokine receptor 4 antibody, in patients with relapsed peripheral T-cell lymphoma and cutaneous t-cell lymphoma. J Clin Oncol. 2014;32(11):1157-1163.
  4. Reddy NM, Evens AM. Chemotherapeutic advancements in peripheral T-cell lymphoma. Semin Hematol. 2014;51(1):17-24.
  5. Karlin L, Coiffier B. The changing landscape of peripheral T-cell lymphoma in the era of novel therapies. Semin Hematol. 2014;51(1):25-34.
  6. Yonekura K, Kanzaki T, Gunshin K, et al. Effect of anti-CCR4 monoclonal antibody (mogamulizumab) on adult T-cell leukemia-lymphoma: cutaneous adverse reactions may predict the prognosis. J Dermatol. 2014;41(3):239-244.
  7. Ishida T, Ito A, Sato F, et al. Stevens-Johnson Syndrome associated with mogamulizumab treatment of adult T-cell leukemia/lymphoma. Cancer Sci. 2013;104(5):647-650.