Mogamulizumab (Specialist drug)

How it works

It binds CCR4 expressed on malignant T cells and, through enhanced antibody-dependent cellular cytotoxicity, promotes their immune-mediated destruction.

Prescribing in practice

• Severe skin reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis, can occur and require prompt interruption and assessment; drug-related rash must be distinguished from disease progression.
• Infusion reactions and increased infection risk occur, and depletion of regulatory T cells raises the risk of immune-related and post-transplant complications.
• It is given by intravenous infusion in a specialist setting, and recent or planned allogeneic transplantation warrants particular caution.

Monitoring

Monitor for skin reactions, infusion reactions, infection and immune-related adverse effects throughout and after treatment.

Counselling the patient

• Report any new or worsening rash, blistering, or mouth or eye soreness straight away.
• Tell the team about fever or other signs of infection without delay.
• Report symptoms during or shortly after the infusion such as chills, flushing or breathlessness.

Evidence & guidelines

The MAVORIC trial supported use in previously treated cutaneous T-cell lymphoma; treatment follows licensed and specialist arrangements.