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NCCN Guidelines for Patients

®

Mycosis Fungoides, Version 1.2016

3

DCIS

Genetic counseling | Treatment

46

4

Treatment guide

Stage IIB treatment

Start with first-line treatments:

Œ

Widespread lesions — 10% or more of the skin

Chart 4.3.3 First-line treatments

Treatment options

• Total skin electron beam therapy

• Systemic treatment ± skin treatment

Group A systemic agents

◦◦ Oral retinoids

◦◦ Interferons

◦◦ HDAC inhibitors (ie,

belinostat,vorinostat,

romidepsin)

◦◦ Extracorporeal photopheresis

◦◦ Methotrexate

Group B systemic agents

◦◦ Brentuximab vedotin

◦◦ Liposomal doxorubicin

◦◦ Gemcitabine

◦◦ Low-dose pralatrexate

◦◦ Chlorambucil

◦◦ Pentostatin

◦◦ Etoposide

◦◦ Cyclophosphamide

◦◦ Temozolomide

◦◦ Low-dose methotrexate

◦◦ Bortezomib

Group C systemic agents

◦◦ Bortezomib

◦◦ Brentuximab vedotin

◦◦ Gemcitabine

◦◦ Liposomal doxorubicin

◦◦ Low- or standard-dose

pralatrexate

◦◦ Romidepsin

Skin treatments

◦◦ Topical steroids

◦◦ Mechlorethamine

◦◦ Local radiation

◦◦ Topical retinoids

◦◦ Phototherapy

◦◦ Topical imiquimod

◦◦ Total skin electron

beam therapy

• Combination treatment

Skin-directed + systemic

◦◦ Phototherapy + retinoid

◦◦ Phototherapy + interferon

◦◦ Phototherapy + photopheresis

◦◦ Total skin electron beam +

photopheresis

Systemic + systemic

◦◦ Retinoid +

interferon

◦◦ Photopheresis

+ retinoid

◦◦ Photopheresis

+

interferon

◦◦ Photopheresis

+ retinoid +

interferon

Try another course of

first-line treatments if:

• Treatment worked at

first but the cancer

came back as stage I

or II, or

• Only 1 or 2

treatments were tried

and didn’t work