Dose-adjusted EPOCH chemotherapy for untreated peripheral T-cell lymphomas: a multicenter phase II trial of West-JHOG PTCL0707

Abstract

The standard CHOP therapy for peripheral T-cell lymphoma has resulted in unsatisfactory outcomes and it is still not clear what is the optimal front-line therapy. We conducted a multicenter phase II study of dose-adjusted etoposide, doxorubicin, and cyclophosphamide with vincristine and prednisone (EPOCH) for untreated peripheral T-cell lymphoma patients. In this prospective study, 41 patients were treated with dose-adjusted-EPOCH as initial therapy: peripheral T-cell lymphoma-not otherwise specified, n=21; angioimmunoblastic T-cell lymphoma, n=17; anaplastic lymphoma kinase-positive anaplastic large cell lymphoma, n=2; and anaplastic lymphoma kinase-negative anaplastic large cell lymphoma, n=1. Median patient age was 64 years (range: 32–79 years). According to the International Prognostic Index criteria, 51.2% were at high-intermediate or high risk. The overall response and complete response rates were 78.0% [95% confidence interval (CI): 62.4–89.4%] and 61.0% (95%CI: 44.5–75.8%), respectively. At the median follow up of 24.0 months, the 2-year progression-free survival and overall survival were 53.3% (95%CI: 36.4–67.5%) and 73.2% (95%CI: 56.8–84.1%), respectively. The younger patients (≤ 60 years old) had a high response rate (overall response 94.1% and complete response 70.6%) and survival rate (progression-free survival 62.5% and overall survival 82.4%). The most common grade ≥ 3 adverse events were neutropenia (74.5%), anemia (40.8%), thrombocytopenia (22.0%), and febrile neutropenia (9.0%). Dose-adjusted-EPOCH had a high response rate with a tolerable toxicity profile. Our results indicate that dose-adjusted-EPOCH is a reasonable first-line approach for peripheral T-cell lymphoma patients and may improve outcomes.

Time to treatment is an independent prognostic factor in aggressive non‐Hodgkin lymphomas

“…Our analysis illustrates how such an exclusion can bias OS estimates. Not only in high-grade DLBCL, but also in BL,(Corazzelli et al, 2012; Dunleavy et al, 2013) MCL,(Ruan et al, 2015; Visco et al, 2013) and even PTCL,(Dupuis et al, 2015; Maeda et al, 2017) many phase 2 trials assert OS or even PFS of 70% or higher. Such trials can strongly influence clinical practice, but clinicians should be mindful of selection factors that produce these very favourable outcomes.…”

How I treat T-cell chronic active Epstein-Barr virus disease

“…Chemotherapeutic regimens used have included DA-EPOCH and CHOP, which have successfully been used to treat patients with T-cell lymphomas. 33,34 In addition, SMILE, a promising chemotherapy for NK-cell malignancies, has also shown some efficacy in a subset of patients with T-cell CAEBV, although the numbers are still small. 23,35 For patients with HLH signs and symptoms, initiating HLH-directed treatment is required.…”

Controversies in the Treatment of Peripheral T‐cell Lymphoma

“… 41 A single arm phase 2 study investigated the use of DA-EPOCH (etoposide, prednisolone, vincristine, cyclophosphamide and doxorubicin). 42 This small trial (41 patients) reported after very short follow-up (median 24 months) showed favorable results with 2-year progression free survival (PFS) and overall survival (OS) of 53% and 73%, respectively. A larger study is needed to confirm these results.…”