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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 early MF‑CTCL aim to relieve the skin symptoms. Options depend on the extent of the skin affected, but may include treatments applied to the skin, such as topical steroids, phototherapy (light therapy) and radiotherapy. Systemic treatment that targets the whole body, such as oral bexarotene, can also be used to relieve skin symptoms if those treatments do not work, no longer work, or become unsuitable.

Clinical evidence shows that chlormethine gel improves skin disease. It may be particularly beneficial for people who have skin disease over a limited area of the body or for whom phototherapy is unsuitable. However, there is no robust evidence for its effectiveness compared with other treatments or showing if it's more effective for people with limited skin disease.

The evidence used to estimate cost effectiveness is uncertain because it does not accurately reflect clinical practice. Other areas of uncertainty include:

  • the true effectiveness of phototherapy, which was used as a comparator in the model

  • how long skin symptoms respond to treatment

  • the amount of chlormethine gel used per day.

The cost effectiveness estimates were also based on a treatment sequence that people do not have in clinical practice. Because of this and the uncertainties around the evidence, the cost-effectiveness estimates are not reliable. The estimates using the preferred assumptions are above what NICE considers a cost-effective use of NHS resources. Therefore, chlormethine gel is not recommended.