Stanford Cancer Center 875 Blake Wilbur Drive Stanford, CA 94305 To refer a patient Phone: 650.498.6000 Faculty: Cutaneous Oncology Youn Kim, MD (Program Director) Howard Chang, MD, PhD Paul Khavari, MD, PhD Radiation Oncologists Richard Hoppe, MD (Program Co-Director) Lynn Million, MD Medical Oncologists Ranjana Advani, MD Michael Khodadoust, MD, PhD Blood & Marrow Transplantation Wen-Kai Weng, MD, PhD (Program Co-Director) Sally Arai, MD Surgical Pathology Jinah Kim, MD, PhD Kerri Rieger, MD, PhD Robert Novoa, MD Christina Kong, MD Websites • cancer.stanford.edu • cutaneouslymphoma.stanford.edu

STANFORD MULTIDISCIPLINARY CUTANEOUS LYMPHOMA PROGRAM (MCLP)

The Stanford Multidsciplinary Cutaneous Lymphoma team offers expert treatment for

patients with cutaneous lymphomas, including mycosis fungoides, Sézary syndrome,

CD30+ lymphoproliferative disorders (lymphomatoid papulosis and anaplastic large cell

lymphoma), subcutaneous panniculitis-like T-cell lymphoma, gamma-delta T-cell

lymphoma, CD8+ aggressive epidermotropic T-cell lymphoma, NK/T-cell lymphoma, other

unspecified cutaneous peripheral T-cell lymphomas, and cutaneous B-cell lymphomas. Our

physicians subspecialize in treating these types of cancers, and have extensive

expert ise in handl ing the most complicated cases. In fact, we serve as the

consultants to the experts. Care among specialists is tightly integrated.

Innovative Discoveries and Treatments

The Stanford team continues its leadership in bringing the state-of-the-art technology

platforms to the clinics testing new diagnostic and prognosticating tools and establishing

biomarkers of clinical outcome. Our multidisciplinary approach allows the most

comprehensive and personalized management of each patient. Moreover, we offer the

newest or novel cancer treatments, such as new targeted and immunotherapies, including

ones that are only available at Stanford. Examples of the new therapies available at

Stanford and their clinical development updates:

• Targeted therapies that attack tumor surface proteins, aberrant epigenetic

regulation, signaling or cell survival pathways, or the microenvironment.

• Mogamulizumab (KW-0761) is a bioengineered, humanized monoclonal antibody

against CCR4, selectively expressed on tumor cells; the defucosylated technology

provides enhanced efficacy. Stanford’s leadership has led to the successful

completion of the phase 3 trial, the results of which is expected to lead to FDA

approval.

• Brentuximab vedotin (SGN-35) is an antibody-drug-conjugate that targets CD30,

commonly expressed on tumor cells in cutaneous T-cell lymphomas. Stanford led

clinical trial in cutaneous T cell lymphoma have shown impressive activity

allowing brentuximab vedotin to be listed in standard of care guidelines.

Stanford’s trial served as the basis for the phase 3 clinical trial that will lead to

official FDA approval.

• Immune checkpoint blockade such as anti-PD-1 monoclonal antibody that unleashes the antitumor effector T cells that fight off malignant T cells in mycosis fungoides and Sézary syndrome. Promising clinical activity has been observed with pembrolizumab and additional immune combination therapy trial is planned.

• Novel macrophage checkpoint blockade, anti-CD47 monoclonal antibody, specifically discovered at Stanford, followed by continued clinical development in solid tumors and lymphoma including cutaneous T cell lymphoma. Blocking the checkpoint with the antibody allows effective phagocytosis of the malignant cells by patient’s own macrophages.

• Anti-KIR3DL2 monoclonal antibody therapy in cutaneous T cell lymphoma. KIR3DL2 is a highly expressed molecule on neoplastic T cell in CTCL, including transformed mycosis fungoides and Sézary syndrome. This antibody works by stimulating the patient’s own immune system to attack the KIR3DL2 expressing cancer cells.

• The oligonucleotide inhibitor (anti-miR) of miR-155-5p in patients with mycosis fungoides. MicroRNAs (miRNAs) are small, non-coding RNAs that act as negative regulators of gene expression. miR-155-5p has been implicated in tumor progression in mycosis fungoides, thus this anti-miR therapy may result in antitumor effects.

• Improved version of denileukin diftitox, a recombinant fusion protein that targets IL-2 receptor (CD25) commonly present on tumor cells in cutaneous T-cell lymphoma. Moreover, CD25 is expressed on a negative immune regulator, namely the regulatory T cells, thus treatment with this agent also depletes these negative regulator cells, whereby enhancing the anti-tumor immune activity. Thus, this agent has both direct action against the tumor cells as well as a bonus indirect effect by augmenting the host immune activity against the tumor cells.

• Low-dose (12 Gy) total skin electron beam therapy combined with recombinant human IL-12, a potent and broad immune activator, to improve the duration of clinical benefit of the total skin radiation therapy. IL-12 is a potent immune enhancing cytokine that works to synergistically boost anti-tumor immune response when combined with radiation therapy.

• Novel/newer topical agents including topical histone deacetylase inhibitor. Preliminary results show encouraging clinical activity with great tolerability, thus confirming that the topical application of histone deacetylase inhibitors can potentially clear patients skin disease without the side effects of the systemically administered counterpart.

• Non-myeloablative allogeneic hematopoietic stem cell transplantation (HSCT) using total skin electron beam therapy, total lymphoid irradiation (TLI), and anti-thymocyte globulin (ATG) as novel preparatory regimen for patients with mycosis fungoides and Sézary syndrome. Stanford's "protective" conditioning regimen allows patients to have curative results with much improved safety profile than conventional allogeneic stem cell transplantation regimens.

• Newer molecular diagnostic methods including TCR high throughput sequencing that offers superior sensitivity and specificity over conventional tools for the identification and monitoring of clonal malignant T cells. This type of technology is actively used to follow cancer activity that is not measurable by conventional methods, thus better defining and predicting if patients can be in long-term remission. Stanford has led the first application of this high throughput technology in patients who received stem cell transplantation and demonstrated that the patients who are clear of molecular disease using this method are more likely to have longer lasting disease-free states and may be cured. The same method is also used to identify distinct malignant clones thus differentiating lymphoma from benign or inflammatory mimics, leading to early and/or more definitive diagnosis.

• Sophisticated in-depth next generation sequencing of tumor tissue and blood to identify driver/actionable new targets, bolstering our investigations towards delivering personalized/precision medicine. Stanford has led investigations to help identify key pathways and molecules used by tumor cells for their survival and spread of cancer. We have developed clinical trials that use therapies that are available or engineered to target these aberrant molecules or pathways.

Unique Integrated Mult idisc ipl inary Care

The Stanford Multidisciplinary Cutaneous Lymphoma Clinic (MCLC) is a national leader in the diagnosis and treatment of patients with

cutaneous lymphomas. In operation for over 35 years at Stanford, the MCLC (similar to a tumor board) is held twice weekly and

patients are jointly evaluated and managed by cutaneous, medical, and radiation oncologists, stem cell transplantation experts, and

pathologists who each have expertise in cutaneous lymphoma. Stanford is unique in offering this interdisciplinary care in cutaneous

lymphoma to provide the most comprehensive and optimal care for patients with this very rare group of lymphomas. Our

Interdisciplinary collaboration extends beyond our clinical care and integrates into our research activities thus bringing new

discoveries that translate into advancing our clinical practice across all related disciplines.

International Leadership

The Stanford MCL team led the efforts in establishing the Cutaneous Lymphoma International Consortium (CLIC), an international

collaborative network of CL expert centers for large scale studies. There are more than 60 international centers that have joined the

CLIC goals to participate in impactful clinical and translational research. Stanford currently serves as CLIC’s coordinating data center

for the collection and management of clinical, pathology, and molecular data linked with a federated (“virtual”) Biobank establishment

at each participating center. This CLIC Biobank will serve as an invaluable repository of clinical (patient) samples linked with

prospectively collected clinical and pathology annotation for future translational research. Through this mechanism, key scientific

discoveries reported from an expert center can be efficiently validated in a larger study at an international level. Thus our

international leadership and large scale collaboration effectively brings the world experts together for greater impact.

CUTANEOUS LYMPHOMA CLINICAL TRIALS

To learn more about active Lymphoma clinical trials, please visit: cancer.stanford.edu/tr ia ls or

cutaneouslymphoma.stanford.edu

• Prospective Multicenter International Observational Study for Determination of a Cutaneous Lymphoma International

Prognostic Index Model and Impact of Major Therapies in Patients with Advanced Mycosis Fungoides and Sézary Syndrome

• Open-Label, Multi-Center, Randomized Study of Anti-CCR4 Monoclonal Antibody KW-0761 (Mogamulizumab) Versus

Vorinostat in Subjects with Previously Treated Cutaneous T Cell Lymphoma

• A Randomized, Open-Label, Phase 3 Trial of Brentuximab Vedotin Versus Physician’s Choice (Methotrexate or Bexarotene) in

Patients with CD30-positive Cutaneous T Cell Lymphoma

• Open Label, Multicenter Phase I Study of IPH4102, a Humanized Anti-KIR3DL2 Monoclonal Antibody, in Patients with

Relapsed/Refractory Cutaneous T-cell Lymphomas

• A Phase 2 Investigator-Initiated Study of MK-3475 (Anti-PD-1, Pembrolizumab) for the Treatment of Relapsed/Refractory

Mycosis Fungoides/Sézary Syndrome

• A Single Arm, Open-Label Study to Evaluate the Safety, Tolerability and Preliminary Efficacy of NM-IL-12 (rHuIL-12) in Patients

with Cutaneous T Cell Lymphoma (CTCL) Undergoing Low Dose Total Skin Electron Beam Therapy (TSEBT)

• A Phase 1 Dose-Ranging Study to Investigate the Safety, Tolerability, and Pharmacokinetics of MRG-106 (anti-miR-155-5p)

Following Local Intratumoral and Subcutaneous Injection in Patients with Cutaneous T Cell Lymphoma (CTCL), Mycosis

Fungoides (MF) Sub-type

• Phase III Study to Demonstrate Safety and Efficacy of E7777 (Denileukin Diftitox) in Persistent or Recurrent Cutaneous T Cell

Lymphoma

• A Phase III Multicenter Randomized, Double-Blind, Placebo-Controlled Study to Determine the Efficacy of Topical SGX301

(Synthetic Hypericin) and Fluorescent-Bulb Light Irradiation for the Treatment of Cutaneous T Cell Lymphoma

• A Phase II Study of Non-myeloablative Allogeneic Transplantation Using Total Lymphoid Irradiation (TLI) and Antithymocyte

Globulin (ATG) In Patients with Cutaneous T Cell Lymphoma

• A First-In-Human Phase 1 Dose Escalation Trial of Hu5F9-G4 In Patients With Advanced Solid Malignancies: Cutaneous T Cell

Lymphoma (CTCL) Translational Cohort

• A Phase 1 Trial of Duvelisib (IPI-145) in Combination with Either Romidepsin or Bortezomib in Relapsed/Refractory T cell

Lymphomas.

SELECTED PUBLICATIONS BY STANFORD MCLP

• Ungewickel l A, Bhaduri A, Rios E, Reuter J, Lee CS, Mah A, Zehnder A, Ohgami R, Kulkarni S, Armstrong R, Gratzinger D,

Tavallaee M, Rook A, Snyder M, Kim Y, Khavari P. Genomic analysis of mycosis fungoides and Sézary syndrome identifies

recurrent alterations in TNFR2. Nat Genet 47:1056-60, 2015

• Hoppe RT, Harrison C, Tavallaee M, Bashey S, Sundram U, Li S, Mil l ion L, Dabaja B, Granger P, Duvic M, Kim YH. Low-dose

total skin electron beam therapy as an effective modality to reduce disease burden in patients with mycosis fungoides:

results of pooled analysis from 3 phase II clinical trials. J Am Acad Dermatol 72:286-92, 2015.

• Duvic M, Pinter-Brown L, Foss FM, Jorgensen JL, Challagundla P, Dwyer KM, Zhang X, Kurman MR, Ballerini R, Liu L, K im YH.

Phase 1/2 study of mogamulizumab, a defucosylated anti-CCR4 antibody, in previously treated patients with cutaneous T-cell

lymphoma. Blood 125:1883-9, 2015

• Qu K, Zaba LC, Giresi PG, Longmire M, Kim YH, Greenleaf WJ, Chang HY. Individuality and variation of personal regulomes

in primary human T cells. Cell Syst 1:51-61, 2015

• Kim YH, Tavallaee MT, Sundram U, Salva KA, Wood GS, Li S, Rozati S, Nagpal S, Krathen M, Reddy S, Hoppe RT, Nguyen-Lin

A, Weng WK, Armstrong R, Pulitzer M, Advani RA, Horwitz SM. Phase II investigator-initiated study of brentuximab vedotin

in mycosis fungoides and Sézary syndrome with variable Cd30 expression level: a multi-institution collaborative project. J Clin

Oncol, 33:3750-8, 2015

• Scarisbrick JJ, K im YH, Whittaker SJ, Wood GS, Vermeer MH, Prince HM, Quaglino P. Prognostic factors, prognostic indices

and staging in mycosis fungoides and Sezary syndrome: where are we now? Br J Dermatol 170:1226-36, 2014.

• Scarisbrick JJ, Prince HM, Vermeer MH, Quaglino P, Horwitz S, Porcu P, Stadler R, Wood G, Beylot-Barry M, Pham-Ledard A,

Foss F, Girardi M, Bagot M, Michel L, Battistella M, Guitart J, Kuzel TM, Martinez-Escala M, Estrach T, Papadavid E, Antoniou C,

Rigopoulos D, Nikolaou V, Sugaya M, Miyagaki T, Gniadecki R, Saches J, Cury-Martins J, Miyashiro D, Servitje O, Muniesa C,

Berti E, Onida F, Corti L, Hodak E, Amitay-Laish I, Ortiz-Romero P, Rodriguez-Peralto J, Knobler R, Porkert S, Bauer W,

Pimpinelli N, Grandi V, Cowan R, Rook A, Kim E, Pileri A, Patrizi A, Pujol R, Wong H, Tyler K, Stranzenbach R, Querfeld C, Fava P,

Maule M, Willemze R, Evison F, Morris S, Twigger R, Talpur R, K im J , Ognibene G, Li S, Tavallaee M, Hoppe RT, Duvic M,

Whittaker SJ, K im YH. Cutaneous Lymphoma International Consortium (CLIC) Study of Outcome in Advanced Stages of

Mycosis Fungoides & Sézary Syndrome: Effect of Specific Prognostic Markers on Survival and Development of a Prognostic

Model. J Clin Oncol 33:3766-73, 2015

• Weng W-K, Armstrong R, Arai S, Desmarais C, Hoppe R, K im YH: Minimal residual disease monitoring with high-

throughput sequencing of T cell receptors in cutaneous T cell lymphoma. Sci Transl Med 5(214):214ra171, 2013

• Amitay-Laish I, Tavallaee M, Kim J , Hoppe RT, Mil l ion L, Feinmesser M, Fenig E, Wolfe ME, Hodak E, K im YH. Pediatric

primary cutaneous marginal zone B-cell lymphoma: Does it differ from the adult counterpart? Br J Dermatol, Epub ahead of

print, 2016

• Bagot M, Porcu P, Ram-Wolff C, Khodadoust M, Battistella M, Marie-Cardine A, Mathieu S, Vermeer M, Whittaker S, Duvic

M, Bensussan A, Paturel C, Bonnafous C, Thonnart N, WidemannA, Bonin C, Sicard H, Paiva C, Pilz K, K im YH. First-in-human,

multicenter phase I study of IPH4102, first-in-class humanized anti-KIR3DL2 monoclonal antibody, in relapsed/refractory

cutaneous T-cell lymphomas. Blood 128(22):1826

• Khodadoust MS, Rook AH, Porcu P, Foss F, Moskowitz A, Shustov AR, Shanbhag S, Sokol L, Shine R, Fling SP, L i S , Rahbar

Z, K im J , Yang Y, Yearley J, Balasubrahmanya P, Maecker H, Dai J , Horwitz SM, Sharon E, Kohrt HE, Cheever MA, Kim YH.

Pembrolizumab for treatment of relapsed/refractory mycosis fungoides and Sézary syndrome: clinical efficacy in a CITN

multicenter phase 2 study. Blood 128(22):181

• Kim YH, Whittaker S, Horwitz SM, Duvic M, Dummer R, Scarisbrick J, Quaglino P, Zinzani PL, Wolter P, Want Y, Palanca-

Wessels MC, Zagadailov E, Trepichhio WL, Liu Y, Little M, Prince HM. Brentuximab vedotin demonstrates significantly

superior clinical outcomes in patients with CD30-expressing cutaneous T-cell lymphoma versus physician’s choice

(methotrexate or bexarotene): the phase 3 ALCANZA study. Blood 128(22):182