Topical treatments for early-stage mycosis fungoides using Grading Recommendations Assessment, Development and Evaluation (GRADE) criteria: A systematic review

Ebba Wennberg; Phillip Q Richards; Paul A Bain; Victor Huang; Sydney D Sullivan; Emanual M Maverakis; Gabriel E Molina; Peggy A Wu

doi:10.1016/j.jdin.2021.01.002

Topical treatments for early-stage mycosis fungoides using Grading Recommendations Assessment, Development and Evaluation (GRADE) criteria: A systematic review

JAAD Int. 2021 Mar 11:3:26-41. doi: 10.1016/j.jdin.2021.01.002. eCollection 2021 Jun.

Authors

Ebba Wennberg¹, Phillip Q Richards², Paul A Bain³, Victor Huang⁴, Sydney D Sullivan⁴, Emanual M Maverakis⁴, Gabriel E Molina⁵, Peggy A Wu⁴

Affiliations

¹ Haematology Department, Kings College Hospital, London, United Kingdom.
² Boston University School of Medicine, Boston, Massachussetts.
³ Countway Library of Medicine, Harvard Medical School, Boston, Massachussetts.
⁴ Department of Dermatology, University of California, Davis, Sacramento, California.
⁵ Harvard Medical School, Boston, Massachussetts.

Abstract

Background: Mycosis fungoides (MF) is a cutaneous lymphoma; most patients present with early, skin-limited disease and are managed by dermatologists.

Objective: The purpose of this study was to systematically review and assess the evidence on topical treatments for early-stage (IA, IB, IIA) MF.

Methods: We performed a literature search via MEDLINE, Embase, Web of Science, and Cochrane databases. Grading Recommendations Assessment, Development and Evaluation (GRADE) criteria were used to assess the certainty of the data.

Results: Two searches yielded 1252 references; 26 met the inclusion criteria and included literature on nitrogen mustard, retinoids, corticosteroids, carmustine, fluorouracil, methotrexate-laurocapram, hexadecylphosphocholine, peldesine, ingenol mebutate, topical methotrexate with oxygen flow-assisted LP3 carrier, and resiquimod. Most studies were single intervention, observational series. Nitrogen mustard, with the most published reports, was effective with 12%-82% early-stage MF patients (total n > 1000) achieving complete remission (CR) (low certainty evidence). Clinical CR was achieved among 10%-60% treated with topical retinoids (low certainty evidence). Two moderate-sized retrospective case series on topical steroids had 18%-63% CR (low certainty evidence). Only single studies were available for the other therapies.

Conclusions: For most outcomes of interest, the GRADE certainty for topical therapies for early-stage MF was low. Further randomized controlled trials and inclusion of quality of life indicators are needed.

Keywords: 5FU, topical fluorouracil; BAD, British Association of Dermatologists; CR, complete remission; GRADE; GRADE, Grading Recommendations Assessment, Development and Evaluation; MF, mycosis fungoides; NCCN, National Comprehensive Cancer Network; OFA-LP3, oxygen flow-assisted LP3 carrier; PR, partial remission; RCT, randomized, controlled, blinded trial; UK, United Kingdom; WHO-EORTC, World Health Organization-European Organisation for Research and Treatment of Cancer; corticosteroids; mycosis fungoides; nitrogen mustard; retinoids; topical treatments.

Publication types

Review