# Mechlorethamine (chlormethine)

Source: https://onco.cc/drugs/mechlorethamine/  
OnCo record `mechlorethamine` (Treatment). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Mechlorethamine, or nitrogen mustard, was the first chemotherapy ever used, in 1940s Hodgkin lymphoma. Today its main use is as a skin gel (Valchlor in the US, Ledaga in Europe) for early cutaneous T-cell lymphoma.

## Summary

Intravenous mechlorethamine (Mustargen, approved 1949) was the M in MOPP, the first curative combination chemotherapy for Hodgkin disease, and was labelled for Hodgkin and non-Hodgkin lymphomas, leukaemias, mycosis fungoides, bronchogenic carcinoma and malignant effusions; the intravenous product has been discontinued in the US. The 0.016% gel (Valchlor) was approved in August 2013 for stage IA and IB mycosis fungoides-type cutaneous T-cell lymphoma after prior skin-directed therapy, on a randomised observer-blinded trial (Study 201) against a compounded ointment; the EU authorised Ledaga in 2017 for the same indication. Contact dermatitis is the main adverse effect of the gel; the intravenous form was a potent vesicant and emetogen.

## Fields

- Kind: Treatment
- Status: approved
- Last checked: 2026-09-24
- Also known as: Nitrogen mustard; Chlormethine; Ledaga
- Tags: nci-list; historic
- Brand: Mustargen (historic) / Valchlor gel
- Modality: Alkylating agent (nitrogen mustard); intravenous and topical gel
- Mechanism: Bifunctional alkylating agent that forms interstrand DNA cross-links; the topical gel acts locally on malignant T cells in the skin.
- Approvals: US 1949: Hodgkin disease and other lymphomas, leukaemias, mycosis fungoides (intravenous; discontinued); US 2013: Topical treatment of stage IA and IB mycosis fungoides-type CTCL after skin-directed therapy (Valchlor); EU 2017: Topical treatment of mycosis fungoides-type CTCL (Ledaga)

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Chlormethine
- Study 201 (JAMA Dermatol 2013): https://doi.org/10.1001/2013.jamadermatol.541
- US label (DailyMed): https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6a52e4c2-6a9f-4ebb-bc77-046b4f8bcd57
- NCI drug page: https://www.cancer.gov/about-cancer/treatment/drugs/mechlorethaminehydrochloride
- EPAR (Ledaga): https://www.ema.europa.eu/en/medicines/human/EPAR/ledaga

## Connected records

- cancers: [Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome)](https://onco.cc/cancers/cutaneous-t-cell-lymphoma/), [Hodgkin lymphoma](https://onco.cc/cancers/hodgkin-lymphoma/), [Mycosis fungoides](https://onco.cc/cancers/mycosis-fungoides/)
- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/)
- companies: [Helsinn](https://onco.cc/companies/helsinn/), [Recordati](https://onco.cc/companies/recordati/)
- trials: [Study 201](https://onco.cc/trials/study-201/)
- terms: [Alkylating agents and therapy-related myeloid neoplasms](https://onco.cc/terms/rejuv-second-alkylating-agents-and-myeloid-neoplasms/), [Skin-directed therapy in mycosis fungoides: creams, light and small radiotherapy fields](https://onco.cc/terms/lymphoma-tx-skin-directed-therapy/), [What the NHS in England funds for lymphoma, appraisal by appraisal](https://onco.cc/terms/lymphoma-tx-uk-access/)
- key papers: [Topical chemotherapy in cutaneous T-cell lymphoma: positive results of a randomized, controlled, multicenter trial testing the efficacy and safety of a novel mechlorethamine, 0.02%, gel in mycosis fungoides](https://onco.cc/key-papers/paper-study-201-jama-dermatol-2013/)

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