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Current treatment approaches in patients with newly diagnosed peripheral T-cell lymphoma and novel therapies-focusing on brentuximab vedotin


Authors: D. Belada
Authors‘ workplace: IV. interní hematologická klinika, FN a LF UK v Hradci Králové
Published in: Transfuze Hematol. dnes,26, 2020, No. 3, p. 177-185.
Category: Review/Educational Papers

Overview

Peripheral T-cell lymphoma (PTCL) is a rare disease with unfavourable prognosis except for low-risk patients with ALK (anaplastic lymphoma kinase)-positive anaplastic large T-cell lymphoma (ALCL). CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) was for many years the standard first line regimen. Addition of etoposide to the CHOP (CHOEP) resulted in better progression-free survival (PFS) but did not confer any overall survival (OS) benefit. The role of autologous stem cell transplantation as consolidation therapy of first line treatment remains unclear in the absence of randomised phase 3 studies. Prognosis of patients failing first line therapy is extremely poor. Apart from a small cohort of young patients who can benefit from salvage therapy with allogeneic stem cell transplantation, there is no standard therapy showing adequate results in the relapse/refractory setting. A recently published phase 3, randomised, double-blind, double dummy study (ECHELON-2) for newly diagnosed CD30-positive patients with PTCL has shown remarkable benefit of brentuximab vedotin (BV, chimeric anti-CD30 antibody with monomethyl auristatin E) when added to CHP chemotherapy in terms of significantly improved PFS as well as OS compared to standard therapy with CHOP, especially in ALCL patients. In other histological subtypes, benefit of BV was difficult to assess given the small numbers of patients and will have to be studied further. Combination of BV and CHP is considered to be a very potent therapy for CD30 positive treatment-naïve PTCL patients. Brentuximab vedotin is newly reimbursed from 01-AUG-2020 in Czech Republic for newly diagnosed patients with CD30-positive T-cell lymphoma, in combination with cyclophosphamid, doxorubicin and prednison.

Keywords:

T-cell lymphoma – Prognosis – brentuximab vedotin – Transplantation


Sources

1. Trněný M. Non-Hodgkinův lymfom v  České republice. Transfuze Hematol Dnes. 2019;25(1):81–86.

2. Anderson JR, Armitage JO, Weisenburger DD. Epidemiology of the non-Hodgkin‘s  lymphomas: distributions of the major subtypes differ by geographic locations. Non-Hodgkin‘s  Lymphoma Classification Project. Ann Oncol. 1998;9(7):717–720.

3. Foss FM, Zinzani PL, Vose JM. Peripheral T-cell lymphoma. Blood. 2011;117(25):6756–6767.

4. Schmitz N, Trümper L, Ziepert M, et al. Treatment and prognosis of mature T-cell and NK-cell lymphoma: an analysis of patients with T-cell lymphoma treated in studies of the German High-Grade NonHodgkin Lymphoma Study Group. Blood. 2010;116(18):3418–3425.

5. Pfreundschuh M, Trümper L, Kloess M, et al. Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of elderly patients with aggressive lymphomas: results of the NHL-B2 trial of the DSHNHL. Blood. 2004;104(3):634–641.

6. Trumper H, Wuff G, Ziepert M, et al. Alemtuzumab added to CHOP for treatment of peripheral T-cell lymphoma (pTNHL) of the elderly: Final results of 116 patients treated in the international ACT-2 phase III trial. J Clin Oncol. 2016;34(15suppl):7500.

7. Dupuis J, Morschhauser F, Ghesquières H, et al. Combination of romidepsin with cyclophosphamide, doxorubicin, vincristine, and prednisone in previously untreated patients with peripheral T-cell lymphoma: a non-randomised, phase 1b/2 study. Lancet Haematol. 2015;2(4):e160–165.

8. Válková V, Trněný M. Současné postavení transplantace krvetvorných buněk v léčbě lymfomů –  přehled. Klin Onkol. 2010;23(3):155–164.

9. d’Amore F, Relander T, Lauritzsen GF, et al. Up-front autologous stem-cell transplantation in peripheral T-cell lymphoma: NLG-T-01. J Clin Oncol. 2012;30(25):3093–3099.

10. Janikova A, Chloupkova R, Campr V, et al. First-line therapy for T cell lymphomas: a retrospective population-based analysis of 906 T cell lymphoma patients. Ann Hematol. 2019;98(8):1961–1972.

11. Bossard C, Dobay MP, Parrens M, et al. Immunohistochemistry as a  valuable tool to assess CD30 expression in peripheral T-cell lymphomas: high correlation with mRNA levels. Blood. 2014;124(19):2983–2986.

12. Sabattini E, Pizzi M, Tabanelli V, et al. CD30 expression in peripheral T-cell lymphomas. Haematologica. 2013;98(8):e81–e82.

13. Forero-Torres A, Leonard JP, Younes A, et al. A Phase II study of SGN-30 (anti-CD30 mAb) in Hodgkin lymphoma or systemic anaplastic large cell lymphoma. Br J Haematol. 2009;146(2):171–179.

14. Pro B, Advani R, Brice P, et al. Brentuximab vedotin (SGN-35) in patients with relapsed or refractory systemic anaplastic large-cell lymphoma: results of a phase II study. J Clin Oncol. 2012;30(18):2190–2196.

15. Fanale MA, Horwitz SM, Forero-Torres A, et al. Brentuximab vedotin in the front-line treatment of patients with CD30+ peripheral T-cell lymphomas: results of a  phase I  study. J Clin Oncol. 2014;32(28):3137–3143.

16. Horwitz S, O’Connor OA, Pro B, et al. Brentuximab vedotin with chemotherapy for CD30-positive peripheral T-cell lymphoma (ECHELON-2): a  global, double-blind, randomised, phase 3 trial. Lancet. 2019;393(10168):229–240.

17. Illidge T, Horwitz S, Iver S, et al. Response to A+CHP by CD30 expression in the ECHELON-2 trial. Hematol Oncol. 2019;37(S2):abstract 228.

18. Savage K, Radvani A, Horwitz S, et al. An exploratory analysis of brentuximab vedotin plus CHP (A+CHP) in the frontline treatment of patients with CD30+ peripheral T-cell lymphomas (ECHELON-2): impact of consolidative stem cell transplant. Blood. 2019;134(Supplement 1):464.

19. Advani RH, Ansell SM, Lechowicz MJ, et al. A  phase II study of cyclophosphamide, etoposide, vincristine and prednisone (CEOP) alternating with pralatrexate (P) as front line therapy for patients with peripheral T-cell lymphoma (PTCL): final results from the T-cell consortium trial. Br J Haematol. 2016;172(4):535–544.

20. Ellin F, Landström J, Jerkeman M, et al. Real-world data on prognostic factors and treatment in peripheral T-cell lymphomas: a study from the Swedish Lymphoma Registry. Blood. 2014;124(10):1570–1577.

21. Belada D, Trněný M a kol. Diagnostické a léčebné postupy u nemocných s  maligními lymfomy. X. vydání [on-line]. Praha: Czech Lymproma Study group, Kooperativní lymfomová skupian, Česká hematologická společnost ČLS JEP, 2018 Dostupné na: https://www.lymphoma.cz/_uploads/attachments/KLS_guidelines_10_2018.pdf

22. Pro B, Advani R, Brice P, et al. Five-year results of brentuximab vedotin in patients with relapsed or refractory systemic anaplastic large cell lymphoma. Blood. 2017;130(25):2709–2717.

23. Horwitz SM, Advani RH, Bartlett NL, et al. Objective responses in relapsed T-cell lymphomas with single-agent brentuximab vedotin. Blood. 2014;123(20):3095–3100.

24. https://www.clinicaltrials.gov.

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Haematology Internal medicine Clinical oncology

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