The following article features coverage from ONS Bridge 2020. Click here to read more of Oncology Nurse Advisor‘s conference coverage.

A standard of care for managing skin flare reactions associated with mogamulizumab infusion in the treatment of patients with mycosis fungoides or Sézary syndrome was described in a poster presentation on the ONS Bridge, a virtual conference.1

Both mycosis fungoides and Sézary syndrome are forms of cutaneous T-cell lymphoma. Malignant T-cells associated with mycosis fungoides generally reside in the skin, whereas Sézary syndrome is characterized by circulating clonal malignant T cells that typically affect the skin. Both conditions are associated with the presence of erythroderma, rashes, and other types of skin lesions, as well as pruritis and pain.

Mogamulizumab-kpkc, a monoclonal antibody directed against CCR4, a CC chemokine receptor, was approved by the US Food and Drug Administration (FDA) in 2018 for the treatment of relapsed/refractory mycosis fungoides and Sézary syndrome in adult patients who have been treated with at least 1 prior line of systemic therapy.2 However, administration of this agent can be complicated by the occurrence of dermatologic toxicity, particularly acute skin flare reactions.

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To facilitate the appropriate management of skin-related adverse effects (AEs) of mogamulizumab while also minimizing infusion scheduling interruptions, a standardized grading system along with supportive care guidelines were developed within the context of a case study series of 12 patients treated with mogamulizumab over a 6-month period.

A key element of this grading system, which characterizes mogamulizumab-related skin toxicity into 4 grades, is that infusion disruption is considered only in the setting of grade 4 skin reactions.

Although no intervention was recommended for patients with grade 1 AEs, defined as “skin eruptions or erythema without associated symptoms,” topical steroid creams were included as an option for patients with grade 2 AEs, described as “skin eruptions or erythema with pruritus, pain, or other associated symptoms.” Both topical and oral steroids were proposed for patients with grade 3 AEs, defined as “widespread skin eruption with erythroderma, ulceration, or vesicular eruption with associated symptoms.”