VALCHLOR® (mechlorethamine) gel is an alkylating drug indicated for the topical treatment of Stage IA and IB mycosis fungoides–type cutaneous T-cell lymphoma (MF-CTCL) in patients who have received prior skin-directed therapy

VALCHLOR—studied in the largest controlled trial of Stage IA/IB MF-CTCL1


The majority of patients responded to treatment with VALCHLOR1

Efficacy was demonstrated by 2 different response scales: CAILS (Composite Assessment of Index Lesion Severity) score and SWAT (Severity Weighted Assessment Tool). Patients were evaluated monthly for the first 6 months, then every 2 months until trial completion.1

Primary endpoint—CAILS
60% overall response rate was achieved by patients receiving VALCHLOR1

The primary study objective was noninferiority comparing VALCHLOR gel to compounded mechlorethamine based on a CAILS overall response rate. VALCHLOR gel was noninferior to compounded mechlorethamine based on the ORR ratio of 1.24 (95% CI 0.98, 1.58).1

60% Overall response

VALCHLOR gel (n=119)

  • Partial response: 45%
  • Complete response: 14%
48% Overall response

Compounded mechlorethamine (n=123)

  • Partial response: 37%
  • Complete response: 11%

Overall response defined as complete response plus partial response. Eighteen patients were excluded from both the CAILS and SWAT efficacy analysis due to protocol violations involving randomization at a single site.1

CAILS Score: Sum severity score of each of the following categories for 5 index lesions: Erythema, scaling, plaque elevation, and surface area1

Response: Partial response defined as ≥50% reduction from baseline CAILS score (confirmed after ≥4 weeks)1; complete response defined as a score of 01

Strong response was confirmed by SWAT score1

Secondary endpoint—SWAT
Half of patients receiving VALCHLOR achieved an overall response1

50% Overall response

VALCHLOR gel (n=119)

  • Partial response: 43%
  • Complete response: 7%
46% Overall response

Compounded mechlorethamine (n=123)

  • Partial response: 43%
  • Complete response: 3%

Overall response defined as complete response plus partial response.1

SWAT Score: Measuring each involved area as a percentage of total BSA, then multiplying it by a severity weighting factor: patch=1; plaque=2; tumor or ulcer=31

Response: Partial response was defined as ≥50% reduction from baseline SWAT score (confirmed after ≥4 weeks); complete response was defined as a score of 01, 2

Click below to hear an expert summarize key findings of the VALCHLOR pivotal trial


VALCHLOR was assessed in a randomized, multicenter, observer-blinded, 12-month noninferiority trial of 260 patients1

Patients with MF-CTCL (N=260)

  • Stage IA, IB, IIA* †
  • ≥1 prior skin-directed therapy
  • Median years of age
    (gel: 57 years; ointment: 58 years)

Randomization (1:1)

VALCHLOR gel 0.016% w/w (Equivalent to 0.02% mechlorethamine HCl) once daily, n=130

Mechlorethamine HCl 0.02% ointment compounded in Aquaphor® once daily, n=130

Patients were stratified before randomization by Stage (IA vs IB and IIA).1

*Stage IA (58.5% gel; 50% ointment), IB (40% gel; 48.5% ointment).2

While Stage IIA patients were included in the trial population, VALCHLOR is only indicated for Stage IA and IB MF-CTCL.1

Patients were not required to be refractory to or indolent of prior skin-directed therapies.1

Concomitant use of topical corticosteroids was not permitted during the study1

  • Mean daily usage of VALCHLOR was 2.8 g (1 to 2 tubes per month); maximum daily usage was 10.5 g (5 to 6 tubes per month)1
Baseline patient characteristics1,3 VALCHLOR gel, %
HCl, %
BSA (body surface area) involvement, median 8.5% (1% to 61%) 9% (1% to 76%)
Received prior topical corticosteroids 86.2% 86.9%
Received prior phototherapy 38.5% 40.8%
Received Bexarotene (topical and oral) 17.7% 17.7%
Received topical mechlorethamine >2 years before study 12.3% 10.0%
Male gender 59.2% 59.2%
White race 74.6% 73.8%
Age 18 to 64 years 71.5% 66.2%


CAILS time to response

Subgroup analysis of the primary endpoint: Efficacy Evaluable Population Group

  • These data are from the pivotal trial, which was a noninferiority trial, and are not contained in the full Prescribing Information for VALCHLOR3
  • These data should not be interpreted as providing better evidence of superiority or evidence that one treatment provides a faster or greater response than the other

Secondary endpoint—CAILS

VALCHLOR achieved a 50% CAILS response rate at 28 weeks3

Graph showcasing the % with response over 52 weeks

  • The Efficacy Evaluable (EE) group is a subset analysis of the Intent to Treat (ITT) population group. EE patients received at least 6 months of study drug, had met the eligibility criteria, and had no significant protocol violations. A total of 72 (28.8%) of enrolled patients were excluded from the EE data set, 39 (15%) of enrolled patients were excluded due to withdrawal for skin toxicity prior to month 6. This is an expected side effect that typically occurs within the first few months of treatment3
  • Time to first confirmed response could occur no sooner than week 8 per the study design3

Approximately 43% of patients receiving VALCHLOR responded at 24 weeks3