The Course of Mycosis Fungoides under Cytokine Pathway Blockers: A Multicentre Analysis of Real-life Clinical Data
Iris Amitay-Laish, Emmanuella Guenova, Pablo L. Ortiz-Romero, Cristina Vico-Alonso, Sima Rozati, Larisa J. Geskin, Vasiliki Nikolaou, Evangelia Papadavid, Aviv Barzilai, Lev Pavlovsky, Elena Didkovsky, Hadas Prag Naveh, Oleg E. Akilov, Emmilia Hodak
Literature regarding the effect of biologics on the course of mycosis fungoides (MF) is scarce. This multicentre study analysed retrospective data on 19 patients with MF, who were treated with biologics; 12 for inflammatory conditions coexisting with MF, and 7 for MF misdiagnosed as an inflammatory skin disease. Eight patients were treated with anti-tumour necrosis factor-α-monotherapy; 6 had early-stage MF, in 3 patients MF preceded and in 3 MF was diagnosed after initiation of biologics, with no stage-progression or with stable disease, respectively (median treatment time concurrent with MF 57 months). Two patients had advanced stage MF: IIB, treated for 15 months with no stage-progression, and IVA1, treated for 8 months, died of disease 10 months later. The other 11/19 patients received anti-interleukin-17A and/or anti-interleukin-12/23 or anti-interleukin-23 (with/without anti-tumour necrosis factor-α/anti-interleukin-4/13), with stage-progression in 8 patients after a median of 8 months’ treatment. Although, in general, biologics should be avoided in patients with MF, these results indicate that anti-tumour necrosis factor-α-monotherapy might not aggravate the disease course in early-stage patients. Interleukin-17A, interleukin-12/23 and interleukin-23 pathway-blockers may prompt progression of MF.
Since, almost as a rule, the treatment of patients with inflammatory conditions with biologics is terminated on diagnosis of mycosis fungoides, information on the course of mycosis fungoides under biologic treatment is scarce. Analysis of real-life data for 19 patients with mycosis fungoides being treated with biologics, revealed that anti-tumour necrosis factor-α-monotherapy may not always adversely affect early-stage disease. In contrast, in the vast majority of patients with mycosis fungoides, continuation of treatment with interleukin-17A, -12/23, and -23 pathway-blockers led to prompt progression of the disease. These observations may guide clinicians in considering the advantages and disadvantages in continuation of tumour necrosis factor-α-blockers in the rare co-occurrence of early-stage mycosis fungoides and inflammatory conditions.