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January 2018

Treatment of CD30-Negative Refractory Mycosis Fungoides With Brentuximab Vedotin

Author Affiliations
  • 1Division of Dermatology, University of Calgary, Calgary, Alberta, Canada
  • 2Department of Dermatology, Mahidol University, Bangkok, Thailand
  • 3Department of Dermatology and Pathology, University of Pennsylvania, Philadelphia
  • 4Division of Hematology-Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia
JAMA Dermatol. 2018;154(1):109-110. doi:10.1001/jamadermatol.2017.3961

Several promising therapies have emerged for advanced-stage cutaneous T-cell lymphoma (CTCL), which has a poor prognosis. We report a case of CD30-negative mycosis fungoides (MF) with a complete response to brentuximab vedotin, a therapy targeted against CD30.

A man in his 60s with stage IIB MF (T3N1M0B0a) was treated with topical clobetasol, topical imiquimod, psoralen–UV-A phototherapy, interferon alfa, interferon gamma, and localized radiotherapy, and all treatments failed. He had a nearly complete response to oral bexarotene and total skin electron beam therapy. However, while undergoing maintenance bexarotene and narrowband UV-B therapy, he developed plaques and ulcerated tumors involving 30% of the body surface (Figure 1), along with fludeoxyglucose-avid lymphadenopathy. A skin biopsy showed large-cell transformation with less than 1% CD30 expression by routine immunohistochemical analysis. His disease progressed after 3 cycles of romidepsin, and he was switched to gemcitabine chemotherapy, but in the first cycle developed neutropenia, infection, and failure to thrive, which prompted preliminary discussions regarding hospice care.