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Chlormethine gel for treating mycosis fungoides-type cutaneous T-cell lymphoma

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1 Recommendations

1.1 Chlormethine gel is not recommended, within its marketing authorisation, for treating mycosis fungoides-type cutaneous T-cell lymphoma (MF-CTCL) in adults.

1.2 This recommendation is not intended to affect treatment with chlormethine gel that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

Why the committee made these recommendations

Most treatments for mycosis fungoides-type cutaneous T-cell lymphoma (MF-CTCL) aim to relieve the skin symptoms. Options include topical treatments, which are applied to the skin, such as topical steroids, phototherapy (light therapy) and radiotherapy. Systemic treatment such as oral bexarotene can also be used to relieve skin symptoms if those treatments become unsuitable.

Clinical evidence shows that chlormethine gel relieves skin symptoms. But there is no robust evidence showing its effectiveness compared with phototherapy.

The evidence used to estimate cost effectiveness is uncertain because it oversimplifies the treatment pathway for people with MF-CTCL and does not reflect clinical practice. Other things that are not certain include:

  • Time to skin symptom progression after response to treatment

  • the length of time people have systemic treatment once skin symptoms progress, and

  • the dose of chlormethine gel per application.

Because of these uncertainties, the committee was unable to estimate the cost effectiveness of chlormethine gel, so it is not recommended.