NCCN Guidelines for Patients
Mycosis Fungoides, Version 1.2016
Genetic counseling | Treatment
Switch to second-line
• Multiple courses of first-line
treatment didn’t work, or
• The cancer is worse and is a
higher cancer stage
Chart 4.3.4 Second-line treatments
• Multi-agent chemotherapy
• Consider allogeneic stem cell transplant
• Clinical trial
Stage IIB treatment
Widespread skin lesions
lists three treatment options for
widespread stage IIB cancers. One option is to treat
all skin lesions with total skin electron beam therapy.
If treatment works, you may receive immunotherapy
for a while to prolong the good results.
The second option is to treat the cancer with systemic
treatment. In addition, skin lesions may be treated
with skin treatment. Treatments in Group A won’t
suppress your immune system while treatments in
Group B and Group C will. Slower-growing cancers
may be treated with Group A and Group B treatments.
Group C treatments are preferred for cancers that
are growing fast. The large-cell transformed subtype
often, but not always, grows fast.
The third option for widespread stage IIB cancers is
combination treatment. Combination treatment may
consist of skin and systemic treatment. It may also
consist of two systemic treatments. Specific regimens
of combination treatment are listed in the chart.
If first-line treatment works, you may stay on your
treatment for a while or slowly stop treatment to
prolong the good results. Start treatment again if the
cancer was fully treated but came back as stage I
or II. People often have good results with the same
treatment. If a new treatment will be received, the
choice of which treatment will be partly based on
how much of your skin has lesions. If one or two
courses of first-line treatment didn’t work, try another
treatment listed in the chart.
You may have already tried multiple courses of first-
line treatment without much change. Sometimes,
despite treatment, the cancer may get worse. In either
case, second-line options are listed in Chart 4.3.4.
lists options for second-line treatment of
stage IIB cancers that were widespread at diagnosis.
There are three options. One option is multi-agent
chemotherapy. Another option is allogeneic stem cell
transplant. The third option is a clinical trial.