251
|
Hux M, Zou D, Ma E, Sajosi P, Engstrom A, Selby R, Benson E, Briggs A, Bonthapally V. A Cost-effectiveness Analysis of Brentuximab Vedotin in Relapsed or Refractory Systemic Anaplastic Large Cell Lymphoma. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2016; 4:188-203. [PMID: 37661948 PMCID: PMC10471416 DOI: 10.36469/9820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Objective: To evaluate the cost-effectiveness of brentuximab vedotin in patients with R/R sALCL from a UK NHS perspective. Methods: A partitioned survival model used clinical outcomes for brentuximab vedotin from the pivotal phase-2 single-arm trial of brentuximab vedotin in 58 patients with R/R sALCL (SG035-0004; NCT00866047), over a lifetime (30-year) time horizon. Comparison with conventional chemotherapy was based on data from the Canadian British Columbia Cancer Agency registry from 40 patients starting salvage chemotherapy after front-line treatment between 1980 and 2012. Survival was extrapolated using parametric distributions, with brentuximab vedotin risk after the trial period assumed equal to conventional chemotherapy. Other modelling assumptions were based on a systematic literature review and clinical expert opinion. Results: Based on statistical extrapolation, brentuximab vedotin was associated with 3.1 years longer duration in the progression-free survival health state and an overall survival improvement of 5.4 years, prior to discounting. In addition, brentuximab vedotin was associated with 2.5 quality-adjusted life years (QALYs) gained at a total incremental cost of £88 556, resulting in an incremental cost-effectiveness ratio (ICER) of approximately £35 400. Sensitivity analyses of alternative model assumptions provided ICERs ranging from approximately £28 100 to £61 900. Comparing only first-line salvage patients reduced the ICER to £26 800 per QALY gained. Conversely, considering only patients with Eastern Corporative Oncology Group performance status of 0 or 1 increased the ICER to approximately £38 200. At a willingness-to-pay threshold of £50 000, the estimated probability that brentuximab vedotin is cost-effective compared with conventional chemotherapy was 86.5%. Conclusion: Compared to conventional chemotherapy, and considering the full survival period, brentuximab vedotin may provide a valuable treatment choice for patients with R/R sALCL, a population with limited therapeutic options.
Collapse
Affiliation(s)
| | | | - Esprit Ma
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Peter Sajosi
- Global Pricing, Market Access and Health Economics Millennium Pharmaceuticals Inc., Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | - Andreas Engstrom
- Market Access and Health Economics, Takeda Pharma AB, Stockholm, Sweden
| | - Ross Selby
- Market Access, Takeda UK Ltd., Bucks, United Kingdom
| | - Eugene Benson
- Market Access, Takeda UK Ltd., Bucks, United Kingdom
| | - Andrew Briggs
- ICON plc, New York, NY, USA; Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Vijayveer Bonthapally
- Global Pricing, Market Access and Health Economics Millennium Pharmaceuticals Inc., Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| |
Collapse
|
252
|
Wang T, Lu Y, Polk A, Chowdhury P, Murga-Zamalloa C, Fujiwara H, Suemori K, Beyersdorf N, Hristov AC, Lim MS, Bailey NG, Wilcox RA. T-cell Receptor Signaling Activates an ITK/NF-κB/GATA-3 axis in T-cell Lymphomas Facilitating Resistance to Chemotherapy. Clin Cancer Res 2016; 23:2506-2515. [PMID: 27780854 DOI: 10.1158/1078-0432.ccr-16-1996] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/16/2016] [Accepted: 10/11/2016] [Indexed: 12/11/2022]
Abstract
Purpose: T-cell lymphomas are a molecularly heterogeneous group of non-Hodgkin lymphomas (NHL) that account for a disproportionate number of NHL disease-related deaths due to their inherent and acquired resistance to standard multiagent chemotherapy regimens. Despite their molecular heterogeneity and frequent loss of various T cell-specific receptors, the T-cell antigen receptor is retained in the majority of these lymphomas. As T-cell receptor (TCR) engagement activates a number of signaling pathways and transcription factors that regulate T-cell growth and survival, we examined the TCR's role in mediating resistance to chemotherapy.Experimental Design: Genetic and pharmacologic strategies were utilized to determine the contribution of tyrosine kinases and transcription factors activated in conventional T cells following TCR engagement in acquired chemotherapy resistance in primary T-cell lymphoma cells and patient-derived cell lines.Results: Here, we report that TCR signaling activates a signaling axis that includes ITK, NF-κB, and GATA-3 and promotes chemotherapy resistance.Conclusions: These observations have significant therapeutic implications, as pharmacologic inhibition of ITK prevented the activation of this signaling axis and overcame chemotherapy resistance. Clin Cancer Res; 23(10); 2506-15. ©2016 AACR.
Collapse
MESH Headings
- Adenine/analogs & derivatives
- Cell Line, Tumor
- Cell Proliferation/drug effects
- Drug Resistance, Neoplasm/genetics
- Drug Resistance, Neoplasm/immunology
- GATA3 Transcription Factor/genetics
- GATA3 Transcription Factor/immunology
- Gene Expression Regulation, Neoplastic/drug effects
- Humans
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/genetics
- Lymphoma, Non-Hodgkin/immunology
- Lymphoma, T-Cell/drug therapy
- Lymphoma, T-Cell/genetics
- Lymphoma, T-Cell/immunology
- NF-kappa B/genetics
- NF-kappa B/immunology
- Piperidines
- Primary Cell Culture
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Protein-Tyrosine Kinases/immunology
- Pyrazoles/administration & dosage
- Pyrimidines/administration & dosage
- Receptors, Antigen, T-Cell/genetics
- Receptors, Antigen, T-Cell/immunology
- Signal Transduction/drug effects
- T-Lymphocytes/immunology
Collapse
Affiliation(s)
- Tianjiao Wang
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | - Ye Lu
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | - Avery Polk
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | - Pinki Chowdhury
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | - Carlos Murga-Zamalloa
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Hiroshi Fujiwara
- Department of Hematology, Clinical Immunology and Infectious Disease, Graduate School of Medicine, Ehime University, Toon, Ehime, Japan
| | - Koichiro Suemori
- Department of Hematology, Clinical Immunology and Infectious Disease, Graduate School of Medicine, Ehime University, Toon, Ehime, Japan
| | - Niklas Beyersdorf
- Institute for Virology and Immunobiology, University of Würzburg, Würzburg, Germany
| | - Alexandra C Hristov
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
| | - Megan S Lim
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nathanael G Bailey
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ryan A Wilcox
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan.
| |
Collapse
|
253
|
Yang YT, Tai CJ, Chen C, Wu HC, Mikhaylichenko N, Chiu HT, Chen YY, Hsu YHE. Highly Diverse Efficacy of Salvage Treatment Regimens for Relapsed or Refractory Peripheral T-Cell Lymphoma: A Systematic Review. PLoS One 2016; 11:e0161811. [PMID: 27711130 PMCID: PMC5053427 DOI: 10.1371/journal.pone.0161811] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 08/12/2016] [Indexed: 12/21/2022] Open
Abstract
Background The goal of this study was to perform a systematic review to examine the efficacy and safety of various salvage therapy regimens on patients with relapsed/refractory PTCL. Method The electronic searches were performed using PubMed, Cochrane Library, EMBASE, and Web of Science from inception through June 2015, with search terms related to relapsed/refractory PTCL, salvage chemotherapy regimens, and clinical trials. An eligible study met the following inclusion criteria: (1) Patients had refractory or relapsed PTCL; (2) drug regimens were used for salvage therapy; (3) the study was a clinical trial; (4) the study reported on a series of at least 10 patients of PTCL. Results Of 35 records identified, a total of 14 studies were eligible for systematic reviews, and 12 different salvage regimens were investigated. A total of 618 relapsed/refractory PTCL patients were identified. The ORRs ranged from 22% for those treated with lenalidomide to 86% for those with brentuximab vedotin. By the three most frequent subtypes, the ORRs ranged from 14.2% to 71.5% for patients with the PTCL-NOS subtype, 8% to 54% for AITL subtypes, and 24% to 86% for the ALCL subtype. The medians of DOR, PFS, and OS ranged from 2.5 to 16.6 months, 2.6 to 13.3 months, and 3.6 to 14.5 months, respectively. The most frequently reported grade 3 or 4 adverse events (AEs) were hematological AEs, such as neutropenia and thrombocytopenia. Conclusion The efficacy of salvage therapy regimens is highly diverse for patients with relapsed/refractory PTCL; this heterogeneity in therapeutic effects might be due to the diversity in mechanisms, PTCL subtype distribution, and/or numbers/profiles of prior therapy. Comparative studies with matched pair analysis are warranted for more evidence of the salvage treatment effect on relapsed or heavily pretreated patients with PTCL.
Collapse
Affiliation(s)
- Ya-Ting Yang
- Institute of Health Policy and Management, National Taiwan University, 17 Xu-Zhou Rd., Taipei, 100, Taiwan
- Golden Dream Think Tank and Research Center, 17 Songjiang Rd., Taipei, 104, Taiwan
- School of Health Care Administration, Taipei Medical University, 250 Wuxing Street, Taipei, Taiwan
| | - Cheng-Jeng Tai
- Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, 252 Wuxing Street, Taipei, 110, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, 250 Wuxing Street, Taipei, 110, Taiwan
| | - Chiehfeng Chen
- Center for Evidence-Based Medicine, Taipei Medical University, 250 Wuxing Street, Taipei, 110, Taiwan
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, 250 Wuxing Street, Taipei, 110, Taiwan
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, NO.111, Section 3, Hsing-Long Rd, Taipei, 116, Taiwan
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, NO.111, Section 3, Hsing-Long Rd, Taipei, 116, Taiwan
| | - Hong-Cheng Wu
- Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, 252 Wuxing Street, Taipei, 110, Taiwan
| | | | - Hsien-Tsai Chiu
- Golden Dream Think Tank and Research Center, 17 Songjiang Rd., Taipei, 104, Taiwan
- Department of Public Health, China Medical University, 91 Hsueh-Shih Road, Taichung, 404, Taiwan
| | - Yun-Yi Chen
- Institute of Health Policy and Management, National Taiwan University, 17 Xu-Zhou Rd., Taipei, 100, Taiwan
- Golden Dream Think Tank and Research Center, 17 Songjiang Rd., Taipei, 104, Taiwan
| | - Yi-Hsin Elsa Hsu
- Golden Dream Think Tank and Research Center, 17 Songjiang Rd., Taipei, 104, Taiwan
- School of Health Care Administration, Taipei Medical University, 250 Wuxing Street, Taipei, Taiwan
- * E-mail:
| |
Collapse
|
254
|
Burudpakdee C, Lin HM, Wang W, Seetasith A, Zhu Y, Bonthapally V, Carson KR. Clinical and economic burden of peripheral T-cell lymphoma in commercially insured patients in the United States: findings using real-world claims data. J Med Econ 2016; 19:965-72. [PMID: 27152635 DOI: 10.1080/13696998.2016.1187622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This retrospective cohort study utilized real-world claims data to assess the clinical and economic burden of peripheral T-cell lymphoma (PTCL) over the continuum of care in the US. METHODS Data were extracted from US administrative claims databases to identify adult patients with PTCL (ICD-9-CM code 202.7X) diagnosed between October 2007 and June 2011. Patients had to have ≥6 months of continuous enrollment before and ≥12 months of continuous enrollment after their index date (date of first PTCL diagnosis). PTCL patients were matched (1:5) by age, sex, region, plan type, payer type, and length of continuous enrollment, to a control group of randomly selected patients without PTCL. Patient-level healthcare resource utilization data and associated costs (in US dollars) were measured. Mean costs per patient per month were determined. RESULTS Of 2820 patients with PTCL, 1000 met all inclusion criteria (median age = 57 years; 57.5% male) and were matched to the control group (n = 5000). On an average monthly basis, PTCL patients were hospitalized more frequently (0.07 vs 0.01 admissions; p < 0.0001) and had a longer length of hospital stay (6.4 vs 4.0 days; p < 0.0001) compared with controls. PTCL patients also had higher monthly utilization of pharmacy services (2.85 vs 0.97 prescriptions; p < 0.0001), office visits (1.35 vs 0.34 visits; p < 0.0001), ER visits (0.07 vs 0.02 visits; p < 0.0001), hospice stays (0.05 vs 0.01 stays; p < 0.0001) and other patient services/procedures. Overall, PTCL patients incurred higher average monthly costs per patient compared with control patients ($6327.84 vs $388.39; p < 0.0001), driven mainly by hospitalizations (32.2% of overall costs) and pharmacy services (19.6%). CONCLUSIONS This is the first real-world study to quantify healthcare resource utilization, costly treatment, and overall medical expenditure in commercially insured PTCL patients. Better tolerated and more effective treatments may improve disease management and reduce the clinical and economic burden of PTCL.
Collapse
Affiliation(s)
- Chakkarin Burudpakdee
- a IMS Health , Fairfax , VA , USA
- b University of North Carolina at Charlotte , Charlotte , NC , USA
| | - Huamao Mark Lin
- c Millennium Pharmaceuticals , Inc., Cambridge , MA , USA , a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | | | | | - Yanyan Zhu
- c Millennium Pharmaceuticals , Inc., Cambridge , MA , USA , a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | - Vijayveer Bonthapally
- c Millennium Pharmaceuticals , Inc., Cambridge , MA , USA , a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | - Kenneth R Carson
- e Washington University School of Medicine , St. Louis , MO , USA
| |
Collapse
|
255
|
Wollina U, Langner D, Hansel G, Haroske G. Pegylated liposomal-encapsulated doxorubicin in cutaneous composite lymphoma: A case report. Medicine (Baltimore) 2016; 95:e4796. [PMID: 27787356 PMCID: PMC5089085 DOI: 10.1097/md.0000000000004796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cutaneous composite lymphomas are very rare. Their treatment depends upon the different contributing lymphoma entities. Peripheral T-cell lymphoma, not otherwise specified, (PTCL-NOS) represents an aggressive lymphoma subtype. Follicular cutaneous B-cell lymphoma (FCBCL) runs an indolent course. Treatment with pegylated liposomal encapsulated doxorubicin (PLE-DOXO) has yet not been reported in this entity. CASE PRESENTATION A 73-year-old male patient presented with 3 rapidly growing, painful nodules on his left leg. He was diagnosed as composite cutaneous lymphoma consisting of PTCL-NOS and FCBCL. All lesions had been surgically removed. Staging was unremarkable. After 4 months a relapse occurred with involvement of inguinal lymph nodes and systemic treatment with PEL-DOXO 20 mg/ m every 3 weeks was initiated. After 6 cycles PLE-DOXO, which were well tolerated without grade 3 or 4 toxicities, a mixed response was obtained with complete remission of cutaneous lesions.Lymph nodes were treated by radiotherapy. A second relapse occurred after 8 months and various polychemotherapy regimens were applied without remission. The overall survival was 28 months. CONCLUSION PEL-DOXO is a possible initial systemic treatment in case of PCTL-NOS. Whether polychemotherapy offers an advantage for survival remains questionable but further investigations are needed.
Collapse
Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Insitute of Pathology “Georg Schmorl”, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
- Correspondence: Uwe Wollina, Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067 Dresden, Germany (e-mail: )
| | | | | | | |
Collapse
|
256
|
Herling M, Rengstl B, Scholtysik R, Hartmann S, Küppers R, Hansmann ML, Diebner HH, Roeder I, Abken H, Newrzela S, Kirberg J. Concepts in mature T-cell lymphomas - highlights from an international joint symposium on T-cell immunology and oncology<sup/>. Leuk Lymphoma 2016; 58:788-796. [PMID: 27643643 DOI: 10.1080/10428194.2016.1222381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Growing attention in mature T-cell lymphomas/leukemias (MTCL) is committed to more accurate and meaningful classifications, improved pathogenetic concepts and expanded therapeutic options. This requires considerations of the immunologic concepts of T-cell homeostasis and the specifics of T-cell receptor (TCR) affinities and signaling. Scientists from various disciplines established the CONTROL-T research unit and in an international conference on MTCL they brought together experts from T-cell immunity, oncology, immunotherapy and systems biology. We report here meeting highlights on the covered topics of diagnostic pitfalls, implications by the new WHO classification, insights from discovered genomic lesions as well as TCR-centric concepts of cellular dynamics in host defense, auto-immunity and tumorigenic clonal escape, including predictions to be derived from in vivo imaging and mathematical modeling. Presentations on novel treatment approaches were supplemented by strategies of optimizing T-cell immunotherapies. Work packages, that in joint efforts would advance the field of MTCL more efficiently, are identified.
Collapse
Affiliation(s)
- Marco Herling
- a Department of Internal Medicine, Center for Integrated Oncology (CIO) Köln-Bonn, Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD) , University of Cologne , Cologne , Germany
| | - Benjamin Rengstl
- b Dr. Senckenberg Institute of Pathology, Goethe-University , Frankfurt/M , Germany
| | - René Scholtysik
- c Institute of Cell Biology (Cancer Research), University of Duisburg-Essen , Essen , Germany
| | - Sylvia Hartmann
- b Dr. Senckenberg Institute of Pathology, Goethe-University , Frankfurt/M , Germany
| | - Ralf Küppers
- c Institute of Cell Biology (Cancer Research), University of Duisburg-Essen , Essen , Germany
| | - Martin-Leo Hansmann
- b Dr. Senckenberg Institute of Pathology, Goethe-University , Frankfurt/M , Germany
| | - Hans H Diebner
- d Faculty of Medicine Carl Gustav Carus , Technische Universität Dresden, Institute for Medical Informatics and Biometry , Dresden , Germany
| | - Ingo Roeder
- d Faculty of Medicine Carl Gustav Carus , Technische Universität Dresden, Institute for Medical Informatics and Biometry , Dresden , Germany
| | - Hinrich Abken
- a Department of Internal Medicine, Center for Integrated Oncology (CIO) Köln-Bonn, Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD) , University of Cologne , Cologne , Germany.,e Center for Molecular Medicine Cologne, University of Cologne , Cologne , Germany
| | - Sebastian Newrzela
- b Dr. Senckenberg Institute of Pathology, Goethe-University , Frankfurt/M , Germany
| | - Jörg Kirberg
- f Division of Immunology , Paul-Ehrlich-Institute , Langen , Germany
| |
Collapse
|
257
|
Townsend W, Johnson RJ, Pottinger BT, Counsell N, Smith P, Chadwick H, Evans K, Wickham C, Rudin CE. A phase II clinical trial of fludarabine and cyclophosphamide followed by thalidomide for angioimmunoblastic T-cell lymphoma. An NCRI clinical trial. CRUK number C17050/A5320. Leuk Lymphoma 2016; 57:2232-4. [PMID: 27001186 DOI: 10.3109/10428194.2015.1133814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- William Townsend
- a Cancer Research UK and University College London Cancer Trials Centre , London , UK
| | - Rod J Johnson
- b The Leeds Teaching Hospitals NHS Trust , Leeds , UK
| | | | - Nicholas Counsell
- a Cancer Research UK and University College London Cancer Trials Centre , London , UK
| | - Paul Smith
- a Cancer Research UK and University College London Cancer Trials Centre , London , UK
| | - Humra Chadwick
- a Cancer Research UK and University College London Cancer Trials Centre , London , UK
| | - Katy Evans
- d Department of Haematology , Royal Devon and Exeter NHS Foundation Trust , Exeter , Devon EX2 5AD , UK
| | - Caroline Wickham
- d Department of Haematology , Royal Devon and Exeter NHS Foundation Trust , Exeter , Devon EX2 5AD , UK
| | - Claudius E Rudin
- d Department of Haematology , Royal Devon and Exeter NHS Foundation Trust , Exeter , Devon EX2 5AD , UK
| |
Collapse
|
258
|
Petrich A, Nabhan C. Use of class I histone deacetylase inhibitor romidepsin in combination regimens. Leuk Lymphoma 2016; 57:1755-65. [PMID: 27118119 PMCID: PMC4950458 DOI: 10.3109/10428194.2016.1160082] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/11/2016] [Accepted: 02/21/2016] [Indexed: 11/13/2022]
Abstract
Histone deacetylase (HDAC) inhibitors are epigenetic-modifying agents that have shown promise as anticancer therapies. Several HDAC inhibitors have been approved by the US Food and Drug Administration (FDA) as single-agent therapies to treat T-cell lymphoma. The synergistic combination of HDAC inhibitors with other anticancer agents has the potential to constitute treatment regimens with enhanced efficacy. Romidepsin is a structurally unique, potent, bicyclic class 1 selective HDAC inhibitor approved by the FDA for the treatment of patients with peripheral T-cell lymphoma who have had at least 1 prior therapy and patients with cutaneous T-cell lymphoma who have had at least 1 prior systemic therapy. Here, we review data that support the use of romidepsin in combination with other anticancer agents for the treatment of various malignancies. Promising results have emerged from early clinical studies, supporting the potential for romidepsin combination regimens to constitute safe and effective treatments for cancer.
Collapse
Affiliation(s)
- Adam Petrich
- Division of Hematology/Oncology, Northwestern University,
Chicago,
IL,
USA
| | - Chadi Nabhan
- Section of Hematology and Oncology, The University of Chicago,
Chicago,
IL,
USA
| |
Collapse
|
259
|
Campbell P, Thomas CM. Belinostat for the treatment of relapsed or refractory peripheral T-cell lymphoma. J Oncol Pharm Pract 2016; 23:143-147. [PMID: 26921086 DOI: 10.1177/1078155216634178] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Peripheral T-cell lymphoma is a heterogenous non-Hodgkin Lymphoma with historically poor outcomes. Currently, response rates remain poor with traditional chemotherapy and many of those responding to initial therapy will relapse. Belinostat (Beleodaq, Spectrum Pharmaceuticals) is a histone deacetylase inhibitor (HDACi) approved for use in relapsed or refractory peripheral T-cell lymphoma (PTCL). Belinostat is metabolized hepatically through cytochrome P-450 enzymes 3A4, 2C9, and 2A6; however, no empiric dosage adjustments of belinostat are recommended during concurrent use of inhibitors or inducers of these enzymes. Belinostat's efficacy has been evaluated in a clinical trial showing an overall response rate (ORR) of 25.8% and a median duration of response of 8.4 months. Belinostat is generally well tolerated, with the most common adverse reactions (>25%) being nausea, vomiting, fatigue, pyrexia, and anemia in patients with relapsed or refractory PTCL. Belinostat is a safe and effective treatment option for relapsed and refractory peripheral T-cell lymphoma, with many future applications currently being investigated.
Collapse
Affiliation(s)
- Peter Campbell
- 1 Department of Pharmacy, NewYork-Presbyterian Hospital, University Hospital of Columbia and Cornell, New York, USA
| | - Christan M Thomas
- 1 Department of Pharmacy, NewYork-Presbyterian Hospital, University Hospital of Columbia and Cornell, New York, USA.,2 Department of Clinical Health Professions, College of Pharmacy, St. John's University, New York, USA
| |
Collapse
|
260
|
Kothari S, Ud-Din N, Lisi M, Coyle T. Crizotinib in anaplastic lymphoma kinase-positive anaplastic large cell lymphoma in the setting of renal insufficiency: a case report. J Med Case Rep 2016; 10:176. [PMID: 27301488 PMCID: PMC4908805 DOI: 10.1186/s13256-016-0963-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 05/31/2016] [Indexed: 12/26/2022] Open
Abstract
Background In vitro studies confirmed cytoreductive anti-tumor activity of crizotinib in experimental models of anaplastic large cell lymphoma in 2007. One case series and a few case reports describe the use of crizotinib in relapsed or refractory anaplastic lymphoma kinase-positive anaplastic large cell lymphoma. Even though data are limited regarding the dose of crizotinib in renal insufficiency, our case was successfully treated with a lower dose of crizotinib. Case presentation We report the case of a 48-year-old white man who had progressive disease after three prior cycles of cyclophosphamide, doxorubicin, vincristine and prednisone and three cycles of ifosfamide, carboplatin, and etoposide, and was not a candidate for high-dose chemotherapy and transplant due to poor performance status and renal insufficiency; he had a complete and durable response to single agent crizotinib. Crizotinib was given at a reduced dose (250 mg once daily) due to his renal insufficiency. He has been in complete remission for more than 2 years. Conclusions Our experience confirms the activity of crizotinib in this disease; it suggests that long-term treatment with crizotinib is a reasonable option in patients who are not candidates for more aggressive therapy and indicates that crizotinib can be used successfully at reduced doses in patients with pre-existing renal insufficiency. The role and timing of crizotinib in anaplastic lymphoma kinase-positive anaplastic large cell lymphoma is unclear, but the current literature that we review here provides promising results that may lead to studies of crizotinib earlier in the course of disease.
Collapse
Affiliation(s)
- Shalin Kothari
- Department of Medicine, SUNY Upstate Medical University, 750 E Adams St., Syracuse, NY, 13210, USA.
| | - Najam Ud-Din
- Division of Hematology/Oncology, Department of Medicine, SUNY Upstate Medical University, 750 E Adams St., Syracuse, NY, 13210, USA
| | - Michele Lisi
- Department of Radiology, SUNY Upstate Medical University, 750 E Adams St., Syracuse, NY, 13210, USA
| | - Thomas Coyle
- Division of Hematology/Oncology, Department of Medicine, SUNY Upstate Medical University, 750 E Adams St., Syracuse, NY, 13210, USA
| |
Collapse
|
261
|
Kim SY, Shin DY, Kim SM, Lee M, Kim EJ. Aberrant DNA methylation-induced gene inactivation is associated with the diagnosis and/or therapy of T-cell leukemias. Leuk Res 2016; 47:116-22. [PMID: 27318093 DOI: 10.1016/j.leukres.2016.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/13/2016] [Accepted: 05/26/2016] [Indexed: 12/31/2022]
Abstract
Aberrant hypermethylation of tumor suppressor genes is known to play an important role in the development of many tumors, and aberrant DNA hypermethylation was recently identified in hematologic malignancies, where it is thought to hold relevance in leukemogenesis. Here, we report that there are differences in the DNA methylation patterns seen in normal peripheral blood and two T-cell leukemia cell lines. We identify nine genes (CLEC4E, CR1, DBC1, EPO, HAL-DOA, IGF2, IL12B, ITGA1, and LMX1B) that are significantly hypermethylated in T-cell leukemias cell lines, and suggest that aberrant hypermethylation of these normally unmethylated genes may induce their transcriptional and expressional silencing. Furthermore, we observed that the expression levels of DNMT1 and DNMT3a were significantly decreased by 5-aza-2'-deoxycytidine (5-Aza-dC), which is a demethylation agent known to deplete DNA methyltransferases (DNMTs) in leukemia cancer cells and restore the expression levels of their target genes in Jurkat cells. This result suggests that the overexpression of DNMTs could contribute to the development of T-cell leukemias by inducing hypermethylation of the target genes. Together, our results show that aberrant hypermethylation is an important molecular mechanism in the progression of T-cell leukemias, and thus could prove useful as a prognostic and/or diagnostic marker. Moreover, 5-Aza-dC might be a promising candidate for the treatment of T-cell leukemia.
Collapse
Affiliation(s)
- Sun Young Kim
- Division of Radiation Effect, Korea Institute of Radiological & Medical Sciences, Seoul 01812, Korea
| | - Dong-Yeop Shin
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Sang-Man Kim
- Health Services Management, KH School of Management, Kyung Hee University, Seoul 02453, Korea
| | - Minyoung Lee
- Division of Radiation Effect, Korea Institute of Radiological & Medical Sciences, Seoul 01812, Korea.
| | - Eun Ju Kim
- Division of Radiation Effect, Korea Institute of Radiological & Medical Sciences, Seoul 01812, Korea; Health Services Management, KH School of Management, Kyung Hee University, Seoul 02453, Korea.
| |
Collapse
|
262
|
Ceritinib in patients with advanced anaplastic lymphoma kinase-rearranged anaplastic large-cell lymphoma. Blood 2016; 126:1257-8. [PMID: 26337354 DOI: 10.1182/blood-2014-12-617779] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
263
|
Pellegrini C, Dodero A, Chiappella A, Monaco F, Degl'Innocenti D, Salvi F, Vitolo U, Argnani L, Corradini P, Zinzani PL. A phase II study on the role of gemcitabine plus romidepsin (GEMRO regimen) in the treatment of relapsed/refractory peripheral T-cell lymphoma patients. J Hematol Oncol 2016; 9:38. [PMID: 27071522 PMCID: PMC4830040 DOI: 10.1186/s13045-016-0266-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 04/06/2016] [Indexed: 11/10/2022] Open
Abstract
Background There is no consensus regarding optimal treatment for peripheral T-cell lymphomas (PTCL), especially in relapsed or refractory cases, which have very poor prognosis and a dismal outcome, with 5-year overall survival of 30 %. Methods A multicenter prospective phase II trial was conducted to investigate the role of the combination of gemcitabine plus romidepsin (GEMRO regimen) in relapsed/refractory PTCL, looking for a potential synergistic effect of the two drugs. GEMRO regimen contemplates an induction with romidepsin plus gemcitabine for six 28-day cycles followed by maintenance with romidepsin for patients in at least partial remission. The primary endpoint was the overall response rate (ORR); secondary endpoints were survival, duration of response, and safety of the regimen. Results The ORR was 30 % (6/20) with 15 % (3) complete response (CR) rate. Two-year overall survival was 50 % and progression-free survival 11.2 %. Grade ≥3 adverse events were represented by thrombocytopenia (60 %), neutropenia (50 %), and anemia (20 %). Two patients are still in CR with median response duration of 18 months. The majority of non-hematological toxicities were mild and transient. No treatment-related death occurred and no toxicity led to treatment interruption. Conclusions GEMRO combination regimen shows efficacy data similar to those of single-agent romidepsin with additional hematologic toxicities. Synergy observed in preclinical phase did not turn into ability to improve clinical outcomes. Trial registration The trial was registered under EudraCT 2012-001404-38; ClinicalTrials.gov number, NCT01822886.
Collapse
Affiliation(s)
- Cinzia Pellegrini
- Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Via Massarenti, 9-40138, Bologna, Italy
| | - Anna Dodero
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Annalisa Chiappella
- Azienda Ospedaliera-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Federico Monaco
- A.O. SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Flavia Salvi
- A.O. SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Umberto Vitolo
- Azienda Ospedaliera-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Lisa Argnani
- Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Via Massarenti, 9-40138, Bologna, Italy
| | - Paolo Corradini
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Pier Luigi Zinzani
- Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Via Massarenti, 9-40138, Bologna, Italy.
| | | |
Collapse
|
264
|
Cottereau A, Becker S, Broussais F, Casasnovas O, Kanoun S, Roques M, Charrier N, Bertrand S, Delarue R, Bonnet C, Hustinx R, Gaulard P, de Leval L, Vera P, Itti E, Mounier N, Haioun C, Tilly H, Meignan M. Prognostic value of baseline total metabolic tumor volume (TMTV0) measured on FDG-PET/CT in patients with peripheral T-cell lymphoma (PTCL). Ann Oncol 2016; 27:719-24. [DOI: 10.1093/annonc/mdw011] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 12/24/2015] [Indexed: 12/13/2022] Open
|
265
|
Lamarque M, Bossard C, Contejean A, Brice P, Parrens M, Le Gouill S, Brière J, Bouabdallah R, Canioni D, Tilly H, Bouchindhomme B, Bachy E, Delarue R, Haioun C, Gaulard P. Brentuximab vedotin in refractory or relapsed peripheral T-cell lymphomas: the French named patient program experience in 56 patients. Haematologica 2016; 101:e103-6. [PMID: 26703966 PMCID: PMC4815738 DOI: 10.3324/haematol.2015.135400] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents/therapeutic use
- Brentuximab Vedotin
- Drug Administration Schedule
- Drug Dosage Calculations
- Female
- France
- Gene Expression Regulation, Neoplastic
- Humans
- Immunoconjugates/therapeutic use
- Ki-1 Antigen/genetics
- Ki-1 Antigen/metabolism
- Lymphoma, T-Cell, Peripheral/drug therapy
- Lymphoma, T-Cell, Peripheral/genetics
- Lymphoma, T-Cell, Peripheral/mortality
- Lymphoma, T-Cell, Peripheral/pathology
- Male
- Middle Aged
- Pilot Projects
- Prognosis
- Recurrence
- Retrospective Studies
- Signal Transduction
- Survival Analysis
Collapse
Affiliation(s)
- Mathilde Lamarque
- Institut IMAGINE, Unité INSERM U1163, Paris, France Département de Pathologie, Groupe Henri-Mondor Albert-Chenevier, Assistance Publique - Hôpitaux de Paris, Créteil, France Unité INSERM U955, Créteil, France
| | - Céline Bossard
- Service d'Anatomie et Cytologie Pathologiques, Centre Hospitalier Universitaire, Hôtel Dieu, Nantes, France
| | - Adrien Contejean
- Unité Hémopathies Lymphoïdes, Groupe Henri Mondor Albert-Chenevier, Assistance Publique - Hôpitaux de Paris, Créteil, France Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, France
| | - Pauline Brice
- Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, France
| | - Marie Parrens
- Département de Pathologie, Hôpital Pessac, Bordeaux, France
| | - Steven Le Gouill
- Service d'Hématologie Clinique, Unité d'Investigation Clinique, Centre Hospitalier Universitaire de Nantes, France Unité INSERM, UMR892 - CNRS, UMR 6299, Université de Nantes, France
| | - Josette Brière
- Département de Pathologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, France
| | - Reda Bouabdallah
- Service d'onco-hématologie adulte, Institut Paoli-Calmettes, Marseille, France
| | - Danielle Canioni
- Département de Pathologie, Hôpital Necker, Assistance Publique, Hôpitaux de Paris, France
| | - Hervé Tilly
- Département d'hématologie clinique, Centre Henri Becquerel, Rouen, France Unité INSERM U918, Centre Henri Becquerel, Rouen, France
| | | | - Emmanuel Bachy
- Département d'hématologie clinique, Hospices Civils de Lyon, Université Claude Bernard Lyon-1, Pierre Bénite, France Unité CNRS UMR5239, Lyon, France Faculté de médecine Lyon Sud Charles Mérieux, Hôpitaux de Paris, France
| | - Richard Delarue
- Service d'Hématologie, Hôpital Necker, Assistance Publique, Hôpitaux de Paris, France
| | - Corinne Haioun
- Unité INSERM U955, Créteil, France Unité Hémopathies Lymphoïdes, Groupe Henri Mondor Albert-Chenevier, Assistance Publique - Hôpitaux de Paris, Créteil, France Université Paris Est, Créteil, France
| | - Philippe Gaulard
- Département de Pathologie, Groupe Henri-Mondor Albert-Chenevier, Assistance Publique - Hôpitaux de Paris, Créteil, France Unité INSERM U955, Créteil, France Université Paris Est, Créteil, France
| |
Collapse
|
266
|
|
267
|
Oregel KZ, Everett E, Zhang X, Nagaraj G. Complete response in a critically ill patient with ALK-negative anaplastic large cell lymphoma treated with single agent brentuximab-vedotin. Expert Rev Anticancer Ther 2016; 16:279-83. [PMID: 26809026 DOI: 10.1586/14737140.2016.1146597] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
UNLABELLED Anaplastic large cell lymphoma (ALCL) is a rare hematological malignancy and a distinct subtype of mature T-cell lymphomas. ALCL is comprised of two clinically distinct but morphologically similar sub-class under 2008 WHO classification: cutaneous and systemic. Primary systemic ALCL is further sub-categorized into tumors that carry the anaplastic lymphoma kinase (ALK) gene rearrangement or not; ALK-positive versus ALK-negative disease respectively. Traditionally, both forms of primary systemic ALCL have been treated upfront with an anthracycline based combination chemotherapy such as CHOP. More recently an antibody drug conjugate, brentuximab-vedotin (BV), directed against CD30 antigen has shown promise in CD30 expressing hematologic malignancies such as Hodgkin's lymphoma and ALCL. At the present time, this novel antibody-drug conjugate has been approved in the treatment of patients with ALCL after failure of at least one prior multi-agent chemotherapy regimen in the United States. We present a case describing a previously healthy 48 year-old female diagnosed with ALK-negative ALCL who achieved complete response with upfront single agent brentuximab-vedotin. It is the first case described in the literature utilizing BV in the first line setting particularly in a patient with multi-organ failure and critically ill at time of diagnosis. This case highlights the full potential that targeted therapies can exert over hematological malignancies while also minimizing treatment related toxicities. ABBREVIATIONS AE: adverse event; ALCL: anaplastic large cell lymphoma; ALK: anaplastic lymphoma kinase; ASCT: autologous stem cell transplant; BEAM: BCNU/carmustine, etoposide, ara-C, and melphalan; BV: brentuximab vedotin; CHEOP: cyclophosphamide, daunorubicin, vincristine, prednisone, etoposide; CHOP: cyclophosphamide, doxorubicin, vincristine, prednisone; CR:complete response; G3+: grade 3 or higher; MTD: maximum tolerated dose; ORR: overall response rate; OS: overall survival; PFS: progression-free survival.
Collapse
Affiliation(s)
- Karlos Z Oregel
- a Hematology and Medical Oncology , Loma Linda University , Loma Linda , CA , United States
| | - Emily Everett
- b Hematology and Medical Oncology Clinical Pharmacy , Loma Linda University , Loma Linda , CA , United States
| | - Xinhai Zhang
- c Department of Pathology and Human Anatomy , Loma Linda University , Loma Linda , CA , United States
| | - Gayathri Nagaraj
- a Hematology and Medical Oncology , Loma Linda University , Loma Linda , CA , United States
| |
Collapse
|
268
|
Biology of peripheral T cell lymphomas – Not otherwise specified: Is something finally happening? ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.pathog.2016.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
269
|
Madokoro Y, Mizuno M, Ookita K, Hagiwara S, Ito A, Matsukawa N. [Angioimmunoblastic T-cell lymphoma suspected to recur in the cranium after complete remission: A case report]. Rinsho Shinkeigaku 2016; 56:112-5. [PMID: 26797482 DOI: 10.5692/clinicalneurol.cn-000804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 46-year-old woman presenting to the Department of Hematology with swelling of the mandibular lymph nodes was diagnosed with angioimmunoblastic T-cell lymphoma (AITL) in June 2013. The patient went into complete remission in December 2013 with chemotherapy; however, she was re-evaluated because of mental confusion during May 2014. In addition to the memory disturbances, elevated cerebrospinal fluid cell count and protein were noted. Fluid attenuated inversion recovery cranial magnetic resonance imaging revealed multiple hyperintense areas in both the mammillary bodies and thalamus accompanied by contrast-enhancing in some areas. The diagnosis of recurrent AITL was made based on the brain biopsy. AITL recurrence in the cranium should be considered in patients exhibiting central nervous system symptoms although such recurrences have not been reported previously.
Collapse
Affiliation(s)
- Yuta Madokoro
- Department of Neurology, Nagoya City University Hospital
| | | | | | | | | | | |
Collapse
|
270
|
Zinzani PL, Bonthapally V, Huebner D, Lutes R, Chi A, Pileri S. Panoptic clinical review of the current and future treatment of relapsed/refractory T-cell lymphomas: Peripheral T-cell lymphomas. Crit Rev Oncol Hematol 2016; 99:214-27. [PMID: 26811013 DOI: 10.1016/j.critrevonc.2015.12.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/11/2015] [Accepted: 12/23/2015] [Indexed: 12/11/2022] Open
Abstract
Peripheral T-cell lymphomas (PTCLs) tend to be aggressive and chemorefractory, with about 70% of patients developing relapsed/refractory disease. Prior to 2009, chemotherapies were the only options for relapsed/refractory PTCL, other than hematopoietic transplants. However, chemotherapy only improves survival by about 1 month compared with palliation. Four drugs are now approved in the US to treat relapsed/refractory PTCL: pralatrexate, romidepsin, belinostat, and brentuximab vedotin (for systemic anaplastic large cell lymphoma [sALCL]). Response rates with pralatrexate, romidepsin, and belinostat range from 25 to 54% in mixed relapsed/refractory PTCL populations, while 86% of sALCL patients respond to brentuximab vedotin. Here, we critically evaluate the evidence supporting the current drug treatment of relapsed/refractory PTCL, and look to the future to see how the treatment panorama may change with the advent of new targeted therapies, some of which (e.g., alisertib in PTCL and mogamulizumab in CCR4-positive adult T-cell leukemia/lymphoma) are already in phase 3 trials.
Collapse
Affiliation(s)
- Pier Luigi Zinzani
- Institute of Hematology 'L. e A. Seràgnoli', Policlinico Sant'Orsola-Malpighi, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
| | - Vijayveer Bonthapally
- Global Outcomes and Epidemiology Research (GOER), Millennium Pharmaceuticals Inc., 40 Lansdowne Street, Cambridge, MA 02139, USA(1)
| | - Dirk Huebner
- Oncology Clinical Research, Millennium Pharmaceuticals Inc., 35 Lansdowne Street, Cambridge, MA 02139, USA(1)
| | - Richard Lutes
- Oncology Clinical Research, Millennium Pharmaceuticals Inc., 35 Lansdowne Street, Cambridge, MA 02139, USA(1)
| | - Andy Chi
- Department of Biostatistics, Millennium Pharmaceuticals Inc., 40 Lansdowne Street, Cambridge, MA 02139, USA(1)
| | - Stefano Pileri
- Department of Experimental, Diagnostic, and Specialty Medicine, Bologna University School of Medicine, Via Massarenti 8, 40138 Bologna, Italy; Unit of Hematopathology, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
| |
Collapse
|
271
|
Bennani-Baiti N, Ansell S, Feldman AL. Adult systemic anaplastic large-cell lymphoma: recommendations for diagnosis and management. Expert Rev Hematol 2015; 9:137-50. [PMID: 26581318 DOI: 10.1586/17474086.2016.1122514] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Systemic anaplastic large-cell lymphomas (sALCLs) comprise a heterogeneous group of relatively rare T-cell non-Hodgkin lymphomas (NHLs) characterized by CD30 expression and other unifying pathologic features. Anaplastic lymphoma kinase (ALK) fusions are present in about 50% of cases. Pathological diagnosis can be challenging, particularly in ALK-negative cases. Though ALK-positive and ALK-negative sALCLs are similar morphologically and immunophenotypically, they are separate entities with different genetics, clinical behavior, and outcomes. Evidence-based data evaluating treatment regimens are limited as randomized controlled trials are lacking and most prospective studies are too small to draw definitive conclusions. However, recent advances in molecular biology are bringing forth much-needed knowledge in this field, and are likely to guide further targeted therapeutic development.
Collapse
Affiliation(s)
| | - Stephen Ansell
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Andrew L Feldman
- b Department of Laboratory Medicine and Pathology , Mayo Clinic , Rochester , MN , USA
| |
Collapse
|
272
|
Barba T, Maucort-Boulch D, Iwaz J, Bohé J, Ninet J, Hot A, Lega JC, Guérin C, Argaud L, Broussolle C, Jamilloux Y, Richard JC, Sève P. Hemophagocytic Lymphohistiocytosis in Intensive Care Unit: A 71-Case Strobe-Compliant Retrospective Study. Medicine (Baltimore) 2015; 94:e2318. [PMID: 26705219 PMCID: PMC4697985 DOI: 10.1097/md.0000000000002318] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a critical condition that may lead to organ failure and early death. The aim of this retrospective observational study was to describe a cohort of HLH patients admitted to intensive care unit (ICU) and investigate the risk factors of early death.A positive HLH diagnosis was defined by an HScore ≥ 169. Univariate and multivariate analyses were carried out to investigate hospital and 28-day mortality risk factors. Between January 2002 and July 2014, 71 HLH cases were seen at our institution.The overall 28-day mortality (start at ICU admission) and hospital mortality were 38% and 68%, respectively. The factors associated with increased 28-day mortality were the sequential organ failure assessment score at ICU admission (P < .001) and advance in age (P = 0.03). The factors associated with increased hospital mortality were a high sequential organ failure assessment score at ICU admission (P < 0.01), advance in age (P = 0.04), and the presence of lymphoma-related HLH or HLH of unknown origin (P < 0.01).Organ failure overtops the classical early-death risk factors in adult ICU-admitted HLH patients. This failure and the subsequent early death may be prevented by timely specific cytotoxic therapies and the control of the underlying disease.
Collapse
Affiliation(s)
- Thomas Barba
- From the Hospices Civils de Lyon, Department of Internal Medicine, Croix-Rousse University Hospital, Lyon; Université Lyon I, Villeurbanne (TB, CB, YJ, PS); Hospices Civils de Lyon, Service de Biostatistique, Lyon; CNRS UMR 5558, Equipe Biostatistique-Santé, Pierre-Bénite; Université Lyon I, Villeurbanne (DM-B, JI); Hospices Civils de Lyon, Intensive Care Unit, Centre Hospitalier Lyon Sud, Pierre-Bénite; Université Lyon I, Villeurbanne (JB); Hospices Civils de Lyon, Department of Internal Medicine, Edouard Herriot University Hospital, Lyon; Université Lyon I (JN, AH); Hospices Civils de Lyon, Department of Internal Medicine, Centre Hospitalier Lyon Sud, Pierre-Bénite; Université Lyon I (JCL); Hospices Civils de Lyon, Intensive Care Unit, Croix-Rousse University Hospital, Lyon; Université Lyon I, Villeurbanne (CG, JCR); and Hospices Civils de Lyon, Intensive Care Unit, Edouard Herriot University Hospital, Lyon; Université Lyon I, Villeurbanne, France (LA)
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
273
|
Fuji S, Fujiwara H, Nakano N, Wake A, Inoue Y, Fukuda T, Hidaka M, Moriuchi Y, Miyamoto T, Uike N, Taguchi J, Eto T, Tomoyose T, Kondo T, Yamanoha A, Ichinohe T, Atsuta Y, Utsunomiya A. Early application of related SCT might improve clinical outcome in adult T-cell leukemia/lymphoma. Bone Marrow Transplant 2015; 51:205-11. [PMID: 26524263 DOI: 10.1038/bmt.2015.265] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 08/31/2015] [Accepted: 09/14/2015] [Indexed: 02/08/2023]
Abstract
Allogeneic hematopoietic SCT (allo-HSCT) is a curative treatment for aggressive adult T-cell leukemia/lymphoma (ATLL). Considering the dismal prognosis associated with conventional chemotherapies, early application of allo-HSCT might be beneficial for patients with ATLL. However, no previous study has addressed the optimal timing of allo-HSCT from related donors. Hence, to evaluate the impact of timing of allo-HSCT for patients with ATLL, we retrospectively analyzed data from patients with ATLL who received an allo-HSCT from a related donor. The median age was 52 years. Patients were grouped according to the interval from diagnosis to allo-HSCT: early transplant group, <100 days, n=72; late transplant group, ⩾100 days, n=428. The corresponding constituents of disease status were not statistically different between the two groups (P=0.11). The probability of OS in the early transplant group was significantly higher than that in the late transplant group (4-year OS, 49.3% vs 31.2%). Multivariate analysis revealed that late allo-HSCT was an unfavorable prognostic factor for OS (hazard ratio, 1.46; 95% confidence interval (CI), 1.01-2.11; P=0.04). Despite the limitations of a retrospective study, it might be acceptable to consider early application of allo-HSCT for ATLL.
Collapse
Affiliation(s)
- S Fuji
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - H Fujiwara
- First Department of Internal Medicine, Ehime University Hospital, Ehime, Japan
| | - N Nakano
- Department of Hematology, Imamura Bun-in Hospital, Kagoshima, Japan
| | - A Wake
- Department of Hematology, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Y Inoue
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - T Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - M Hidaka
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Y Moriuchi
- Department of Hematology, Sasebo City General Hospital, Nagasaki, Japan
| | - T Miyamoto
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka, Japan
| | - N Uike
- Department of Hematology, National Kyushu Cancer Center, Fukuoka, Japan
| | - J Taguchi
- Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Nagasaki University Hospital, Nagasaki, Japan
| | - T Eto
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - T Tomoyose
- Second Department of Internal Medicine, Endocrinology, Diabetes and Metabolism, Hematology and Rheumatology, University Hospital, University of the Ryukyus, Okinawa, Japan
| | - T Kondo
- Department of Hematology/Oncology, Kyoto University Hospital, Kyoto, Japan
| | - A Yamanoha
- Department of Haematology, Heart-Life Hospital, Okinawa, Japan
| | - T Ichinohe
- Department of Hematology and Oncology, Hiroshima University Hospital, Hiroshima, Japan
| | - Y Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.,Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - A Utsunomiya
- Department of Hematology, Imamura Bun-in Hospital, Kagoshima, Japan
| | | |
Collapse
|
274
|
Zullo KM, Guo Y, Cooke L, Jirau-Serrano X, Mangone M, Scotto L, Amengual JE, Mao Y, Nandakumar R, Cremers S, Duong J, Mahadevan D, O'Connor OA. Aurora A Kinase Inhibition Selectively Synergizes with Histone Deacetylase Inhibitor through Cytokinesis Failure in T-cell Lymphoma. Clin Cancer Res 2015; 21:4097-109. [PMID: 25878331 PMCID: PMC4581881 DOI: 10.1158/1078-0432.ccr-15-0033] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/24/2015] [Indexed: 01/23/2023]
Abstract
PURPOSE Aurora A kinase (AAK) is expressed exclusively during mitosis, and plays a critical role in centrosome duplication and spindle formation. Alisertib is a highly selective AAK inhibitor that has demonstrated marked clinical activity of alisertib across a spectrum of lymphomas, though particularly in patients with T-cell lymphoma (TCL). We sought to compare and contrast the activity of alisertib in preclinical models of B-cell lymphoma (BCL) and TCL, and identify combinations worthy of clinical study. High-throughput screening of pralatrexate, the proteasome inhibitor (ixazomib), and the histone deacetylase (HDAC) inhibitor (romidepsin) revealed that only romidepsin synergized with alisertib, and only in models of TCL. We discovered that the mechanism of synergy between AAK inhibitors and HDAC inhibitors appears to be mediated through cytokinesis failure. EXPERIMENTAL DESIGN A high-throughput screening approach was used to identify drugs that were potentially synergistic in combination with alisertib. Live-cell imaging was used to explore the mechanistic basis for the drug: drug interaction between alisertib and romidepsin. An in vivo xenograft TCL model was used to confirm in vitro results. RESULTS In vitro, alisertib exhibited concentration-dependent cytotoxicity in BCL and TCL cell lines. Alisertib was synergistic with romidepsin in a T-cell-specific fashion that was confirmed in vivo. Live-cell imaging demonstrated that the combination treatment resulted in profound cytokinesis failure. CONCLUSIONS These data strongly suggest that the combination of alisertib and romidepsin is highly synergistic in TCL through modulation of cytokinesis and merits clinical development.
Collapse
Affiliation(s)
- Kelly M Zullo
- Department of Medicine, Center for Lymphoid Malignancies, Columbia University Medical Center, New York, New York
| | - Yige Guo
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Laurence Cooke
- University of Tennessee Health Science Center, West Cancer Center, Memphis, Tennessee
| | - Xavier Jirau-Serrano
- Department of Medicine, Center for Lymphoid Malignancies, Columbia University Medical Center, New York, New York
| | - Michael Mangone
- Department of Medicine, Center for Lymphoid Malignancies, Columbia University Medical Center, New York, New York
| | - Luigi Scotto
- Department of Medicine, Center for Lymphoid Malignancies, Columbia University Medical Center, New York, New York
| | - Jennifer E Amengual
- Department of Medicine, Center for Lymphoid Malignancies, Columbia University Medical Center, New York, New York
| | - Yinghui Mao
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Renu Nandakumar
- Irving Institute for Clinical and Translational Research, Columbia University Medical Center, New York, New York
| | - Serge Cremers
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York. Irving Institute for Clinical and Translational Research, Columbia University Medical Center, New York, New York
| | - Jimmy Duong
- Mailman School of Public Health, Columbia University, New York, New York
| | - Daruka Mahadevan
- University of Tennessee Health Science Center, West Cancer Center, Memphis, Tennessee
| | - Owen A O'Connor
- Department of Medicine, Center for Lymphoid Malignancies, Columbia University Medical Center, New York, New York.
| |
Collapse
|
275
|
Zinzani PL, Corradini P, Gianni AM, Federico M, Santoro A, Vitolo U, Barosi G, Tura S. Brentuximab Vedotin in CD30-Positive Lymphomas: A SIE, SIES, and GITMO Position Paper. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015. [DOI: 10.1016/j.clml.2015.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
276
|
Ansell SM. Non-Hodgkin Lymphoma: Diagnosis and Treatment. Mayo Clin Proc 2015; 90:1152-63. [PMID: 26250731 DOI: 10.1016/j.mayocp.2015.04.025] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/20/2015] [Accepted: 04/28/2015] [Indexed: 12/13/2022]
Abstract
Non-Hodgkin lymphomas are lymphoid malignant neoplasms with diverse biological and clinical behavior. Patients typically present with persistent painless lymphadenopathy, but some patients may present with constitutional symptoms or with involvement of organs other than the lymphoid and hematopoietic system. An accurate diagnosis, careful staging of the disease, and identification of adverse prognostic factors form the basis of treatment selection. Patients commonly receive chemoimmunotherapy as initial treatment, and radiation therapy may be added if patients have early-stage disease. Most patients respond well to treatment, but relapses are frequent and additional therapies including stem cell transplant are often needed. Because many subtypes of lymphoma remain incurable with current management strategies, clinical trials are in progress to identify novel therapies with promising activity in this disease.
Collapse
|
277
|
Tan D, Phipps C, Hwang WYK, Tan SY, Yeap CH, Chan YH, Tay K, Lim ST, Lee YS, Kumar SG, Ng SC, Fadilah S, Kim WS, Goh YT. Panobinostat in combination with bortezomib in patients with relapsed or refractory peripheral T-cell lymphoma: an open-label, multicentre phase 2 trial. LANCET HAEMATOLOGY 2015; 2:e326-33. [DOI: 10.1016/s2352-3026(15)00097-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/18/2015] [Accepted: 05/20/2015] [Indexed: 01/03/2023]
|
278
|
Combination therapy for relapsed peripheral T-cell lymphoma: is two better than one? LANCET HAEMATOLOGY 2015; 2:e307-8. [DOI: 10.1016/s2352-3026(15)00116-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 06/16/2015] [Indexed: 11/22/2022]
|
279
|
Marchi E, Zullo KM, Amengual JE, Kalac M, Bongero D, McIntosh CM, Fogli LK, Rossi M, Zinzani PL, Pileri SA, Piccaluga PP, Fuligni F, Scotto L, O'Connor OA. The combination of hypomethylating agents and histone deacetylase inhibitors produce marked synergy in preclinical models of T-cell lymphoma. Br J Haematol 2015; 171:215-226. [PMID: 26194163 DOI: 10.1111/bjh.13566] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 05/12/2015] [Indexed: 01/27/2023]
Abstract
T-cell lymphomas (TCL) are aggressive lymphomas usually treated with CHOP (cyclophsophamide, doxorubicin, vincristine, prednisolone)-like regimens upfront. Recent data suggest that TCL are driven by epigenetic defects, potentially rendering them sensitive to epigenetic therapies. We explored the therapeutic merits of a combined epigenetic platform using histone deacetylase inhibitors (HDACIs) and DNA methyltransferase inhibitors (DNMT) in in vitro and in vivo models of TCL. The 50% inhibitory concentration (IC50 ) values revealed romidepsin was the most potent HDACI, with an IC50 in the low nanomolar range. The combination with a hypomethylating agent produced synergy across all cell lines, which was confirmed in cytotoxicity and apoptosis assays. An in vivo xenograft study demonstrated inhibition of tumour growth in the combination cohort compared to the single agent. Gene expression array and global methylation profiling revealed differentially expressed genes and modulated pathways for each of the single treatment conditions and the combination. Most of the effects induced by the single agent treatment were maintained in the combination group. In total, 944 unique genes were modulated by the combination treatment, supporting the hypothesis of molecular synergism. These data suggest combinations of hypomethylating agents and HDACIs are synergistic in models of TCL, which is supported at the molecular level.
Collapse
Affiliation(s)
- Enrica Marchi
- Department of Medicine; Center for Lymphoid Malignancies; Columbia University Medical Center; New York NY USA
| | - Kelly M. Zullo
- Department of Medicine; Center for Lymphoid Malignancies; Columbia University Medical Center; New York NY USA
| | - Jennifer E. Amengual
- Department of Medicine; Center for Lymphoid Malignancies; Columbia University Medical Center; New York NY USA
| | - Matko Kalac
- Department of Medicine; Center for Lymphoid Malignancies; Columbia University Medical Center; New York NY USA
| | - Danielle Bongero
- Department of Medicine; Center for Lymphoid Malignancies; Columbia University Medical Center; New York NY USA
| | - Christine M. McIntosh
- Department of Medicine; Center for Lymphoid Malignancies; Columbia University Medical Center; New York NY USA
| | - Laura K. Fogli
- Department of Pathology; NYU School of Medicine; New York NY USA
| | - Maura Rossi
- Department of Hematology and Oncological Sciences “L. and A. Seràgnoli”; S. Orsola Malpighi Hospital; Unit of Hematopathology; University of Bologna; Bologna Italy
| | - Pier L. Zinzani
- Department of Hematology and Oncological Sciences “L. and A. Seràgnoli”; S. Orsola Malpighi Hospital; Unit of Hematopathology; University of Bologna; Bologna Italy
| | - Stefano A. Pileri
- Department of Hematology and Oncological Sciences “L. and A. Seràgnoli”; S. Orsola Malpighi Hospital; Unit of Hematopathology; University of Bologna; Bologna Italy
| | - Pier P. Piccaluga
- Department of Hematology and Oncological Sciences “L. and A. Seràgnoli”; S. Orsola Malpighi Hospital; Unit of Hematopathology; University of Bologna; Bologna Italy
| | - Fabio Fuligni
- Department of Hematology and Oncological Sciences “L. and A. Seràgnoli”; S. Orsola Malpighi Hospital; Unit of Hematopathology; University of Bologna; Bologna Italy
| | - Luigi Scotto
- Department of Medicine; Center for Lymphoid Malignancies; Columbia University Medical Center; New York NY USA
| | - Owen A. O'Connor
- Department of Medicine; Center for Lymphoid Malignancies; Columbia University Medical Center; New York NY USA
| |
Collapse
|
280
|
Denileukin Diftitox (Ontak) as Maintenance Therapy for Peripheral T-Cell Lymphomas: Three Cases with Sustained Remission. Case Rep Oncol Med 2015; 2015:123756. [PMID: 26240767 PMCID: PMC4512602 DOI: 10.1155/2015/123756] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/25/2015] [Accepted: 07/05/2015] [Indexed: 11/19/2022] Open
Abstract
Peripheral T-cell lymphomas (PTCL) are rare but markedly aggressive forms of non-Hodgkin's lymphoma (NHL). They carry a poor prognosis, with current therapeutic approach being generally ineffective. The most employed first-line treatment is CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone), which still results in high rates of relapses. Denileukin diftitox is a fusion protein combining the cytotoxic portion of the diphtheria toxin and the receptor-binding domain of the interleukin-2 (IL-2) molecule, thereby targeting cells expressing the IL-2 receptor, including both T-cell and B-cell lymphomas. It has been approved for the treatment of cutaneous T-cell lymphomas, and it has documented activity in PTCL both as a single agent and as part of combination therapy. This report documents three cases of PTCL where denileukin diftitox has been used as long-term maintenance therapy after complete remission was achieved. While the overall survival rate of patients with advanced stage, refractory PTCL is generally poor (with median overall survival of 5.5 months), the three patients described in this report are all experiencing an ongoing complete remission for more than four years.
Collapse
|
281
|
Bates SE, Eisch R, Ling A, Rosing D, Turner M, Pittaluga S, Prince HM, Kirschbaum MH, Allen SL, Zain J, Geskin LJ, Joske D, Popplewell L, Cowen EW, Jaffe ES, Nichols J, Kennedy S, Steinberg SM, Liewehr DJ, Showe LC, Steakley C, Wright J, Fojo T, Litman T, Piekarz RL. Romidepsin in peripheral and cutaneous T-cell lymphoma: mechanistic implications from clinical and correlative data. Br J Haematol 2015; 170:96-109. [PMID: 25891346 PMCID: PMC4675455 DOI: 10.1111/bjh.13400] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 02/04/2015] [Indexed: 01/02/2023]
Abstract
Romidepsin is an epigenetic agent approved for the treatment of patients with cutaneous or peripheral T-cell lymphoma (CTCL and PTCL). Here we report data in all patients treated on the National Cancer Institute 1312 trial, demonstrating long-term disease control and the ability to retreat patients relapsing off-therapy. In all, 84 patients with CTCL and 47 with PTCL were enrolled. Responses occurred early, were clinically meaningful and of very long duration in some cases. Notably, patients with PTCL receiving romidepsin as third-line therapy or later had a comparable response rate (32%) of similar duration as the total population (38%). Eight patients had treatment breaks of 3.5 months to 10 years; in four of six patients, re-initiation of treatment led to clear benefit. Safety data show slightly greater haematological and constitutional toxicity in PTCL. cDNA microarray studies show unique individual gene expression profiles, minimal overlap between patients, and both induction and repression of gene expression that reversed within 24 h. These data argue against cell death occurring as a result of an epigenetics-mediated gene induction programme. Together this work supports the safety and activity of romidepsin in T-cell lymphoma, but suggests a complex mechanism of action.
Collapse
Affiliation(s)
- Susan E. Bates
- Developmental Therapeutics Branch, NCI, NIH, Bethesda, MD
| | - Robin Eisch
- Developmental Therapeutics Branch, NCI, NIH, Bethesda, MD
| | - Alex Ling
- Department of Radiology, Warren G Magnuson Clinical Center, NIH, Bethesda, MD
| | | | | | | | - H. Miles Prince
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Mark H. Kirschbaum
- Hematological Malignancies, Penn State Hershey Medical Center, Hershey, PA
| | - Steven L. Allen
- Hofstra North Shore-LIJ School of Medicine and Monter Cancer Center, Lake Success, NY
| | | | - Larisa J. Geskin
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - David Joske
- Sir Charles Gairdner Hospital, Nedlands, Western Australia
| | | | | | | | | | | | | | | | | | | | - John Wright
- Cancer Therapy Evaluation Program, DCTDC, NCI, Bethesda, MD
| | - Tito Fojo
- Center for Cancer Research, NCI, Bethesda, MD
| | | | | |
Collapse
|
282
|
Shi Y, Dong M, Hong X, Zhang W, Feng J, Zhu J, Yu L, Ke X, Huang H, Shen Z, Fan Y, Li W, Zhao X, Qi J, Huang H, Zhou D, Ning Z, Lu X. Results from a multicenter, open-label, pivotal phase II study of chidamide in relapsed or refractory peripheral T-cell lymphoma. Ann Oncol 2015; 26:1766-71. [PMID: 26105599 DOI: 10.1093/annonc/mdv237] [Citation(s) in RCA: 240] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 05/11/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Chidamide is a novel benzamide type of subtype-selective histone deacetylase (HDAC) inhibitor with unique mechanisms of action compared with marketed HDAC inhibitors. This phase II study was to evaluate the efficacy and safety of chidamide in relapsed or refractory peripheral T-cell lymphoma (PTCL) in Chinese population. PATIENTS AND METHODS Patients with relapsed or refractory PTCL of different subtypes received chidamide of 30 mg orally twice per week. The primary end point was overall response rate (ORR). Responding patients should be confirmed at least 4 weeks after the criteria of the response were first met, and were reviewed by an independent review committee. RESULTS Eighty-three patients were enrolled and 79 patients with eligible PTCL histology were for efficacy assessments. Patients enrolled over 10% were with subtypes of PTCL not otherwise specified (34%), anaplastic large-cell lymphoma (22%), extranodal natural killer (NK)/T-cell lymphoma, nasal type (20%), or angioimmunoblastic T-cell lymphoma (AITL, 13%). The ORR was 28% (22 of 79) including 14% (11 of 79) with complete response/unconfirmed complete response (CR/CRu). Median progression-free survival and overall survival were 2.1 and 21.4 months, respectively. AITL patients tended to have higher ORR (50%) and CR/CRu rate (40%), as well as more durable responses, to chidamide treatment. Most adverse events (AEs) were grade 1 or 2, and AEs ≥grade 3 that occurred in ≥10% patients were thrombocytopenia (22%), leucopenia (13%) and neutropenia (11%), respectively. CONCLUSION Chidamide represents a novel oral benzamide class of HDAC inhibitor with significant single-agent activity and manageable toxicity in relapsed or refractory PTCL, and provides a much needed treatment option in this indication in China. Results led to China Food and Drug Administration approval of chidamide in this indication.
Collapse
Affiliation(s)
- Y Shi
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing
| | - M Dong
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing
| | - X Hong
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai
| | - W Zhang
- Department of Lymphoma, 307 Hospital of PLA, Beijing
| | - J Feng
- Department of Medical Oncology, Jiangsu Cancer Hospital, Nanjing
| | - J Zhu
- Department of Medical Oncology, Beijing Caner Hospital, Beijing
| | - L Yu
- Department of Hematology, Chinese PLA General Hospital, Beijing
| | - X Ke
- Department of Hematology, Peking University Third Hospital, Beijing
| | - H Huang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou
| | - Z Shen
- Department of Hematology, Ruijin Hospital/Medical College, Shanghai Jiao Tong University, Shanghai
| | - Y Fan
- Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou
| | - W Li
- Department of Hematology, the First Hospital, Jilin University, Changchun
| | - X Zhao
- Department of Hematology, Xiangya Hospital Central South University, Changsha
| | - J Qi
- Department of Lymphoma, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin
| | - H Huang
- Department of Hematology, the First Affiliated Hospital, Zhejiang University, Hangzhou
| | - D Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing
| | - Z Ning
- Chipscreen Biosciences Ltd, Shenzhen, China
| | - X Lu
- Chipscreen Biosciences Ltd, Shenzhen, China
| |
Collapse
|
283
|
O'Connor OA, Horwitz S, Masszi T, Van Hoof A, Brown P, Doorduijn J, Hess G, Jurczak W, Knoblauch P, Chawla S, Bhat G, Choi MR, Walewski J, Savage K, Foss F, Allen LF, Shustov A. Belinostat in Patients With Relapsed or Refractory Peripheral T-Cell Lymphoma: Results of the Pivotal Phase II BELIEF (CLN-19) Study. J Clin Oncol 2015; 33:2492-9. [PMID: 26101246 DOI: 10.1200/jco.2014.59.2782] [Citation(s) in RCA: 357] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Peripheral T-cell lymphomas (PTCLs) represent a diverse group of non-Hodgkin lymphomas with a poor prognosis and no accepted standard of care for patients with relapsed or refractory disease. This study evaluated the efficacy and tolerability of belinostat, a novel histone deacetylase inhibitor, as a single agent in relapsed or refractory PTCL. PATIENTS AND METHODS Patients with confirmed PTCL who experienced progression after ≥ one prior therapy received belinostat 1,000 mg/m(2) as daily 30-minute infusions on days 1 to 5 every 21 days. Central assessment of response used International Working Group criteria. Primary end point was overall response rate. Secondary end points included duration of response (DoR) and progression-free and overall survival. RESULTS A total of 129 patients were enrolled, with a median of two prior systemic therapies. Overall response rate in the 120 evaluable patients was 25.8% (31 of 120), including 13 complete (10.8%) and 18 partial responses (15%). Median DoR by International Working Group criteria was 13.6 months, with the longest ongoing patient at ≥ 36 months. Median progression-free and overall survival were 1.6 and 7.9 months, respectively. Twelve of the enrolled patients underwent stem-cell transplantation after belinostat monotherapy. The most common grade 3 to 4 adverse events were anemia (10.8%), thrombocytopenia (7%), dyspnea (6.2%), and neutropenia (6.2%). CONCLUSION Monotherapy with belinostat produced complete and durable responses with manageable toxicity in patients with relapsed or refractory PTCL across the major subtypes, irrespective of number or type of prior therapies. These results have led to US Food and Drug Administration approval of belinostat for this indication.
Collapse
Affiliation(s)
- Owen A O'Connor
- Owen A. O'Connor, Columbia University Medical Center; Steven Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Tamás Masszi, St Istvan and St Laszlo Hospital, Budapest, Hungary; Achiel Van Hoof, General Hospital St-Jan, Brugge, Belgium; Peter Brown, Rigshospitalet; Poul Knoblauch, Topotarget, Copenhagen, Denmark; Jeannette Doorduijn, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Wojciech Jurczak, Jagiellonian University, Krakow; Jan Walewski, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland; Shanta Chawla, Gajanan Bhat, Mi Rim Choi, and Lee F. Allen, Spectrum Pharmaceuticals, Irvine, CA; Kerry Savage, British Columbia Cancer Agency Centre, Vancouver, British Columbia, Canada; Francine Foss, Yale Cancer Center, New Haven, CT; and Andrei Shustov, University of Washington Medical Center, Seattle, WA.
| | - Steven Horwitz
- Owen A. O'Connor, Columbia University Medical Center; Steven Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Tamás Masszi, St Istvan and St Laszlo Hospital, Budapest, Hungary; Achiel Van Hoof, General Hospital St-Jan, Brugge, Belgium; Peter Brown, Rigshospitalet; Poul Knoblauch, Topotarget, Copenhagen, Denmark; Jeannette Doorduijn, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Wojciech Jurczak, Jagiellonian University, Krakow; Jan Walewski, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland; Shanta Chawla, Gajanan Bhat, Mi Rim Choi, and Lee F. Allen, Spectrum Pharmaceuticals, Irvine, CA; Kerry Savage, British Columbia Cancer Agency Centre, Vancouver, British Columbia, Canada; Francine Foss, Yale Cancer Center, New Haven, CT; and Andrei Shustov, University of Washington Medical Center, Seattle, WA
| | - Tamás Masszi
- Owen A. O'Connor, Columbia University Medical Center; Steven Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Tamás Masszi, St Istvan and St Laszlo Hospital, Budapest, Hungary; Achiel Van Hoof, General Hospital St-Jan, Brugge, Belgium; Peter Brown, Rigshospitalet; Poul Knoblauch, Topotarget, Copenhagen, Denmark; Jeannette Doorduijn, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Wojciech Jurczak, Jagiellonian University, Krakow; Jan Walewski, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland; Shanta Chawla, Gajanan Bhat, Mi Rim Choi, and Lee F. Allen, Spectrum Pharmaceuticals, Irvine, CA; Kerry Savage, British Columbia Cancer Agency Centre, Vancouver, British Columbia, Canada; Francine Foss, Yale Cancer Center, New Haven, CT; and Andrei Shustov, University of Washington Medical Center, Seattle, WA
| | - Achiel Van Hoof
- Owen A. O'Connor, Columbia University Medical Center; Steven Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Tamás Masszi, St Istvan and St Laszlo Hospital, Budapest, Hungary; Achiel Van Hoof, General Hospital St-Jan, Brugge, Belgium; Peter Brown, Rigshospitalet; Poul Knoblauch, Topotarget, Copenhagen, Denmark; Jeannette Doorduijn, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Wojciech Jurczak, Jagiellonian University, Krakow; Jan Walewski, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland; Shanta Chawla, Gajanan Bhat, Mi Rim Choi, and Lee F. Allen, Spectrum Pharmaceuticals, Irvine, CA; Kerry Savage, British Columbia Cancer Agency Centre, Vancouver, British Columbia, Canada; Francine Foss, Yale Cancer Center, New Haven, CT; and Andrei Shustov, University of Washington Medical Center, Seattle, WA
| | - Peter Brown
- Owen A. O'Connor, Columbia University Medical Center; Steven Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Tamás Masszi, St Istvan and St Laszlo Hospital, Budapest, Hungary; Achiel Van Hoof, General Hospital St-Jan, Brugge, Belgium; Peter Brown, Rigshospitalet; Poul Knoblauch, Topotarget, Copenhagen, Denmark; Jeannette Doorduijn, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Wojciech Jurczak, Jagiellonian University, Krakow; Jan Walewski, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland; Shanta Chawla, Gajanan Bhat, Mi Rim Choi, and Lee F. Allen, Spectrum Pharmaceuticals, Irvine, CA; Kerry Savage, British Columbia Cancer Agency Centre, Vancouver, British Columbia, Canada; Francine Foss, Yale Cancer Center, New Haven, CT; and Andrei Shustov, University of Washington Medical Center, Seattle, WA
| | - Jeannette Doorduijn
- Owen A. O'Connor, Columbia University Medical Center; Steven Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Tamás Masszi, St Istvan and St Laszlo Hospital, Budapest, Hungary; Achiel Van Hoof, General Hospital St-Jan, Brugge, Belgium; Peter Brown, Rigshospitalet; Poul Knoblauch, Topotarget, Copenhagen, Denmark; Jeannette Doorduijn, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Wojciech Jurczak, Jagiellonian University, Krakow; Jan Walewski, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland; Shanta Chawla, Gajanan Bhat, Mi Rim Choi, and Lee F. Allen, Spectrum Pharmaceuticals, Irvine, CA; Kerry Savage, British Columbia Cancer Agency Centre, Vancouver, British Columbia, Canada; Francine Foss, Yale Cancer Center, New Haven, CT; and Andrei Shustov, University of Washington Medical Center, Seattle, WA
| | - Georg Hess
- Owen A. O'Connor, Columbia University Medical Center; Steven Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Tamás Masszi, St Istvan and St Laszlo Hospital, Budapest, Hungary; Achiel Van Hoof, General Hospital St-Jan, Brugge, Belgium; Peter Brown, Rigshospitalet; Poul Knoblauch, Topotarget, Copenhagen, Denmark; Jeannette Doorduijn, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Wojciech Jurczak, Jagiellonian University, Krakow; Jan Walewski, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland; Shanta Chawla, Gajanan Bhat, Mi Rim Choi, and Lee F. Allen, Spectrum Pharmaceuticals, Irvine, CA; Kerry Savage, British Columbia Cancer Agency Centre, Vancouver, British Columbia, Canada; Francine Foss, Yale Cancer Center, New Haven, CT; and Andrei Shustov, University of Washington Medical Center, Seattle, WA
| | - Wojciech Jurczak
- Owen A. O'Connor, Columbia University Medical Center; Steven Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Tamás Masszi, St Istvan and St Laszlo Hospital, Budapest, Hungary; Achiel Van Hoof, General Hospital St-Jan, Brugge, Belgium; Peter Brown, Rigshospitalet; Poul Knoblauch, Topotarget, Copenhagen, Denmark; Jeannette Doorduijn, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Wojciech Jurczak, Jagiellonian University, Krakow; Jan Walewski, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland; Shanta Chawla, Gajanan Bhat, Mi Rim Choi, and Lee F. Allen, Spectrum Pharmaceuticals, Irvine, CA; Kerry Savage, British Columbia Cancer Agency Centre, Vancouver, British Columbia, Canada; Francine Foss, Yale Cancer Center, New Haven, CT; and Andrei Shustov, University of Washington Medical Center, Seattle, WA
| | - Poul Knoblauch
- Owen A. O'Connor, Columbia University Medical Center; Steven Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Tamás Masszi, St Istvan and St Laszlo Hospital, Budapest, Hungary; Achiel Van Hoof, General Hospital St-Jan, Brugge, Belgium; Peter Brown, Rigshospitalet; Poul Knoblauch, Topotarget, Copenhagen, Denmark; Jeannette Doorduijn, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Wojciech Jurczak, Jagiellonian University, Krakow; Jan Walewski, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland; Shanta Chawla, Gajanan Bhat, Mi Rim Choi, and Lee F. Allen, Spectrum Pharmaceuticals, Irvine, CA; Kerry Savage, British Columbia Cancer Agency Centre, Vancouver, British Columbia, Canada; Francine Foss, Yale Cancer Center, New Haven, CT; and Andrei Shustov, University of Washington Medical Center, Seattle, WA
| | - Shanta Chawla
- Owen A. O'Connor, Columbia University Medical Center; Steven Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Tamás Masszi, St Istvan and St Laszlo Hospital, Budapest, Hungary; Achiel Van Hoof, General Hospital St-Jan, Brugge, Belgium; Peter Brown, Rigshospitalet; Poul Knoblauch, Topotarget, Copenhagen, Denmark; Jeannette Doorduijn, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Wojciech Jurczak, Jagiellonian University, Krakow; Jan Walewski, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland; Shanta Chawla, Gajanan Bhat, Mi Rim Choi, and Lee F. Allen, Spectrum Pharmaceuticals, Irvine, CA; Kerry Savage, British Columbia Cancer Agency Centre, Vancouver, British Columbia, Canada; Francine Foss, Yale Cancer Center, New Haven, CT; and Andrei Shustov, University of Washington Medical Center, Seattle, WA
| | - Gajanan Bhat
- Owen A. O'Connor, Columbia University Medical Center; Steven Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Tamás Masszi, St Istvan and St Laszlo Hospital, Budapest, Hungary; Achiel Van Hoof, General Hospital St-Jan, Brugge, Belgium; Peter Brown, Rigshospitalet; Poul Knoblauch, Topotarget, Copenhagen, Denmark; Jeannette Doorduijn, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Wojciech Jurczak, Jagiellonian University, Krakow; Jan Walewski, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland; Shanta Chawla, Gajanan Bhat, Mi Rim Choi, and Lee F. Allen, Spectrum Pharmaceuticals, Irvine, CA; Kerry Savage, British Columbia Cancer Agency Centre, Vancouver, British Columbia, Canada; Francine Foss, Yale Cancer Center, New Haven, CT; and Andrei Shustov, University of Washington Medical Center, Seattle, WA
| | - Mi Rim Choi
- Owen A. O'Connor, Columbia University Medical Center; Steven Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Tamás Masszi, St Istvan and St Laszlo Hospital, Budapest, Hungary; Achiel Van Hoof, General Hospital St-Jan, Brugge, Belgium; Peter Brown, Rigshospitalet; Poul Knoblauch, Topotarget, Copenhagen, Denmark; Jeannette Doorduijn, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Wojciech Jurczak, Jagiellonian University, Krakow; Jan Walewski, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland; Shanta Chawla, Gajanan Bhat, Mi Rim Choi, and Lee F. Allen, Spectrum Pharmaceuticals, Irvine, CA; Kerry Savage, British Columbia Cancer Agency Centre, Vancouver, British Columbia, Canada; Francine Foss, Yale Cancer Center, New Haven, CT; and Andrei Shustov, University of Washington Medical Center, Seattle, WA
| | - Jan Walewski
- Owen A. O'Connor, Columbia University Medical Center; Steven Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Tamás Masszi, St Istvan and St Laszlo Hospital, Budapest, Hungary; Achiel Van Hoof, General Hospital St-Jan, Brugge, Belgium; Peter Brown, Rigshospitalet; Poul Knoblauch, Topotarget, Copenhagen, Denmark; Jeannette Doorduijn, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Wojciech Jurczak, Jagiellonian University, Krakow; Jan Walewski, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland; Shanta Chawla, Gajanan Bhat, Mi Rim Choi, and Lee F. Allen, Spectrum Pharmaceuticals, Irvine, CA; Kerry Savage, British Columbia Cancer Agency Centre, Vancouver, British Columbia, Canada; Francine Foss, Yale Cancer Center, New Haven, CT; and Andrei Shustov, University of Washington Medical Center, Seattle, WA
| | - Kerry Savage
- Owen A. O'Connor, Columbia University Medical Center; Steven Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Tamás Masszi, St Istvan and St Laszlo Hospital, Budapest, Hungary; Achiel Van Hoof, General Hospital St-Jan, Brugge, Belgium; Peter Brown, Rigshospitalet; Poul Knoblauch, Topotarget, Copenhagen, Denmark; Jeannette Doorduijn, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Wojciech Jurczak, Jagiellonian University, Krakow; Jan Walewski, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland; Shanta Chawla, Gajanan Bhat, Mi Rim Choi, and Lee F. Allen, Spectrum Pharmaceuticals, Irvine, CA; Kerry Savage, British Columbia Cancer Agency Centre, Vancouver, British Columbia, Canada; Francine Foss, Yale Cancer Center, New Haven, CT; and Andrei Shustov, University of Washington Medical Center, Seattle, WA
| | - Francine Foss
- Owen A. O'Connor, Columbia University Medical Center; Steven Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Tamás Masszi, St Istvan and St Laszlo Hospital, Budapest, Hungary; Achiel Van Hoof, General Hospital St-Jan, Brugge, Belgium; Peter Brown, Rigshospitalet; Poul Knoblauch, Topotarget, Copenhagen, Denmark; Jeannette Doorduijn, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Wojciech Jurczak, Jagiellonian University, Krakow; Jan Walewski, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland; Shanta Chawla, Gajanan Bhat, Mi Rim Choi, and Lee F. Allen, Spectrum Pharmaceuticals, Irvine, CA; Kerry Savage, British Columbia Cancer Agency Centre, Vancouver, British Columbia, Canada; Francine Foss, Yale Cancer Center, New Haven, CT; and Andrei Shustov, University of Washington Medical Center, Seattle, WA
| | - Lee F Allen
- Owen A. O'Connor, Columbia University Medical Center; Steven Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Tamás Masszi, St Istvan and St Laszlo Hospital, Budapest, Hungary; Achiel Van Hoof, General Hospital St-Jan, Brugge, Belgium; Peter Brown, Rigshospitalet; Poul Knoblauch, Topotarget, Copenhagen, Denmark; Jeannette Doorduijn, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Wojciech Jurczak, Jagiellonian University, Krakow; Jan Walewski, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland; Shanta Chawla, Gajanan Bhat, Mi Rim Choi, and Lee F. Allen, Spectrum Pharmaceuticals, Irvine, CA; Kerry Savage, British Columbia Cancer Agency Centre, Vancouver, British Columbia, Canada; Francine Foss, Yale Cancer Center, New Haven, CT; and Andrei Shustov, University of Washington Medical Center, Seattle, WA
| | - Andrei Shustov
- Owen A. O'Connor, Columbia University Medical Center; Steven Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Tamás Masszi, St Istvan and St Laszlo Hospital, Budapest, Hungary; Achiel Van Hoof, General Hospital St-Jan, Brugge, Belgium; Peter Brown, Rigshospitalet; Poul Knoblauch, Topotarget, Copenhagen, Denmark; Jeannette Doorduijn, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Wojciech Jurczak, Jagiellonian University, Krakow; Jan Walewski, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland; Shanta Chawla, Gajanan Bhat, Mi Rim Choi, and Lee F. Allen, Spectrum Pharmaceuticals, Irvine, CA; Kerry Savage, British Columbia Cancer Agency Centre, Vancouver, British Columbia, Canada; Francine Foss, Yale Cancer Center, New Haven, CT; and Andrei Shustov, University of Washington Medical Center, Seattle, WA
| |
Collapse
|
284
|
Barr PM, Li H, Spier C, Mahadevan D, LeBlanc M, Ul Haq M, Huber BD, Flowers CR, Wagner-Johnston ND, Horwitz SM, Fisher RI, Cheson BD, Smith SM, Kahl BS, Bartlett NL, Friedberg JW. Phase II Intergroup Trial of Alisertib in Relapsed and Refractory Peripheral T-Cell Lymphoma and Transformed Mycosis Fungoides: SWOG 1108. J Clin Oncol 2015; 33:2399-404. [PMID: 26077240 DOI: 10.1200/jco.2014.60.6327] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Aurora A kinase (AAK) is upregulated in highly proliferative lymphomas, suggesting its potential as a therapeutic target. Alisertib is a novel oral AAK inhibitor without adverse safety signals in early-phase studies that demonstrated preliminary activity in T-cell lymphoma. This phase II study was conducted to further investigate the efficacy of alisertib in relapsed or refractory peripheral T-cell non-Hodgkin lymphoma (PTCL). PATIENTS AND METHODS Eligible patients with histologically confirmed relapsed/refractory PTCL or transformed Mycosis fungoides (tMF) received alisertib 50 mg twice a day for 7 days on 21-day cycles. RESULTS Of 37 eligible patients, the histologic subtypes enrolled included PTCL not otherwise specified (n = 13), angioimmunoblastic T-cell lymphoma (n = 9), tMF (n = 7), adult T-cell lymphoma/leukemia (n = 4), anaplastic large-cell lymphoma (n = 2), and extranodal natural killer/T-cell lymphoma (n = 2). Grade 3 and 4 adverse events in ≥ 5% of patients included neutropenia (32%), anemia (30%), thrombocytopenia (24%), febrile neutropenia (14%), mucositis (11%), and rash (5%). Treatment was discontinued most commonly for disease progression. Among the PTCL subtypes, the overall response rate was 30%, whereas no responses were observed in tMF. Aurora B kinase was more commonly overexpressed than AAK in tumor specimens. Analysis of AAK, Aurora B kinase, MYC, BCL-2, phosphatidylinositol 3-kinase γ, and Notch1 expression revealed no association with response. CONCLUSION Alisertib has antitumor activity in PTCL, including heavily pretreated patients. These promising results are being further investigated in an ongoing international, randomized phase III trial comparing alisertib with investigator's choice in PTCL.
Collapse
Affiliation(s)
- Paul M Barr
- Paul M. Barr and Jonathan W. Friedberg, University of Rochester, Rochester; Steven M. Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Hongli Li and Michael LeBlanc, SWOG Statistical Office, Seattle, WA; Catherine Spier, University of Arizona College of Medicine, Tucson, AZ; Daruka Mahadevan, Mansoor Ul Haq, and Bryan D. Huber, University of Tennessee Health Sciences Center, Memphis, TN; Christopher R. Flowers, Emory University, Atlanta, GA; Nina D. Wagner-Johnston and Nancy L. Bartlett, Washington University School of Medicine, St. Louis, MO; Richard I. Fisher, Temple University, Philadelphia, PA; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Sonali M. Smith, The University of Chicago, Chicago, IL; and Brad S. Kahl, University of Wisconsin, Madison, WI.
| | - Hongli Li
- Paul M. Barr and Jonathan W. Friedberg, University of Rochester, Rochester; Steven M. Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Hongli Li and Michael LeBlanc, SWOG Statistical Office, Seattle, WA; Catherine Spier, University of Arizona College of Medicine, Tucson, AZ; Daruka Mahadevan, Mansoor Ul Haq, and Bryan D. Huber, University of Tennessee Health Sciences Center, Memphis, TN; Christopher R. Flowers, Emory University, Atlanta, GA; Nina D. Wagner-Johnston and Nancy L. Bartlett, Washington University School of Medicine, St. Louis, MO; Richard I. Fisher, Temple University, Philadelphia, PA; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Sonali M. Smith, The University of Chicago, Chicago, IL; and Brad S. Kahl, University of Wisconsin, Madison, WI
| | - Catherine Spier
- Paul M. Barr and Jonathan W. Friedberg, University of Rochester, Rochester; Steven M. Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Hongli Li and Michael LeBlanc, SWOG Statistical Office, Seattle, WA; Catherine Spier, University of Arizona College of Medicine, Tucson, AZ; Daruka Mahadevan, Mansoor Ul Haq, and Bryan D. Huber, University of Tennessee Health Sciences Center, Memphis, TN; Christopher R. Flowers, Emory University, Atlanta, GA; Nina D. Wagner-Johnston and Nancy L. Bartlett, Washington University School of Medicine, St. Louis, MO; Richard I. Fisher, Temple University, Philadelphia, PA; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Sonali M. Smith, The University of Chicago, Chicago, IL; and Brad S. Kahl, University of Wisconsin, Madison, WI
| | - Daruka Mahadevan
- Paul M. Barr and Jonathan W. Friedberg, University of Rochester, Rochester; Steven M. Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Hongli Li and Michael LeBlanc, SWOG Statistical Office, Seattle, WA; Catherine Spier, University of Arizona College of Medicine, Tucson, AZ; Daruka Mahadevan, Mansoor Ul Haq, and Bryan D. Huber, University of Tennessee Health Sciences Center, Memphis, TN; Christopher R. Flowers, Emory University, Atlanta, GA; Nina D. Wagner-Johnston and Nancy L. Bartlett, Washington University School of Medicine, St. Louis, MO; Richard I. Fisher, Temple University, Philadelphia, PA; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Sonali M. Smith, The University of Chicago, Chicago, IL; and Brad S. Kahl, University of Wisconsin, Madison, WI
| | - Michael LeBlanc
- Paul M. Barr and Jonathan W. Friedberg, University of Rochester, Rochester; Steven M. Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Hongli Li and Michael LeBlanc, SWOG Statistical Office, Seattle, WA; Catherine Spier, University of Arizona College of Medicine, Tucson, AZ; Daruka Mahadevan, Mansoor Ul Haq, and Bryan D. Huber, University of Tennessee Health Sciences Center, Memphis, TN; Christopher R. Flowers, Emory University, Atlanta, GA; Nina D. Wagner-Johnston and Nancy L. Bartlett, Washington University School of Medicine, St. Louis, MO; Richard I. Fisher, Temple University, Philadelphia, PA; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Sonali M. Smith, The University of Chicago, Chicago, IL; and Brad S. Kahl, University of Wisconsin, Madison, WI
| | - Mansoor Ul Haq
- Paul M. Barr and Jonathan W. Friedberg, University of Rochester, Rochester; Steven M. Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Hongli Li and Michael LeBlanc, SWOG Statistical Office, Seattle, WA; Catherine Spier, University of Arizona College of Medicine, Tucson, AZ; Daruka Mahadevan, Mansoor Ul Haq, and Bryan D. Huber, University of Tennessee Health Sciences Center, Memphis, TN; Christopher R. Flowers, Emory University, Atlanta, GA; Nina D. Wagner-Johnston and Nancy L. Bartlett, Washington University School of Medicine, St. Louis, MO; Richard I. Fisher, Temple University, Philadelphia, PA; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Sonali M. Smith, The University of Chicago, Chicago, IL; and Brad S. Kahl, University of Wisconsin, Madison, WI
| | - Bryan D Huber
- Paul M. Barr and Jonathan W. Friedberg, University of Rochester, Rochester; Steven M. Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Hongli Li and Michael LeBlanc, SWOG Statistical Office, Seattle, WA; Catherine Spier, University of Arizona College of Medicine, Tucson, AZ; Daruka Mahadevan, Mansoor Ul Haq, and Bryan D. Huber, University of Tennessee Health Sciences Center, Memphis, TN; Christopher R. Flowers, Emory University, Atlanta, GA; Nina D. Wagner-Johnston and Nancy L. Bartlett, Washington University School of Medicine, St. Louis, MO; Richard I. Fisher, Temple University, Philadelphia, PA; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Sonali M. Smith, The University of Chicago, Chicago, IL; and Brad S. Kahl, University of Wisconsin, Madison, WI
| | - Christopher R Flowers
- Paul M. Barr and Jonathan W. Friedberg, University of Rochester, Rochester; Steven M. Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Hongli Li and Michael LeBlanc, SWOG Statistical Office, Seattle, WA; Catherine Spier, University of Arizona College of Medicine, Tucson, AZ; Daruka Mahadevan, Mansoor Ul Haq, and Bryan D. Huber, University of Tennessee Health Sciences Center, Memphis, TN; Christopher R. Flowers, Emory University, Atlanta, GA; Nina D. Wagner-Johnston and Nancy L. Bartlett, Washington University School of Medicine, St. Louis, MO; Richard I. Fisher, Temple University, Philadelphia, PA; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Sonali M. Smith, The University of Chicago, Chicago, IL; and Brad S. Kahl, University of Wisconsin, Madison, WI
| | - Nina D Wagner-Johnston
- Paul M. Barr and Jonathan W. Friedberg, University of Rochester, Rochester; Steven M. Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Hongli Li and Michael LeBlanc, SWOG Statistical Office, Seattle, WA; Catherine Spier, University of Arizona College of Medicine, Tucson, AZ; Daruka Mahadevan, Mansoor Ul Haq, and Bryan D. Huber, University of Tennessee Health Sciences Center, Memphis, TN; Christopher R. Flowers, Emory University, Atlanta, GA; Nina D. Wagner-Johnston and Nancy L. Bartlett, Washington University School of Medicine, St. Louis, MO; Richard I. Fisher, Temple University, Philadelphia, PA; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Sonali M. Smith, The University of Chicago, Chicago, IL; and Brad S. Kahl, University of Wisconsin, Madison, WI
| | - Steven M Horwitz
- Paul M. Barr and Jonathan W. Friedberg, University of Rochester, Rochester; Steven M. Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Hongli Li and Michael LeBlanc, SWOG Statistical Office, Seattle, WA; Catherine Spier, University of Arizona College of Medicine, Tucson, AZ; Daruka Mahadevan, Mansoor Ul Haq, and Bryan D. Huber, University of Tennessee Health Sciences Center, Memphis, TN; Christopher R. Flowers, Emory University, Atlanta, GA; Nina D. Wagner-Johnston and Nancy L. Bartlett, Washington University School of Medicine, St. Louis, MO; Richard I. Fisher, Temple University, Philadelphia, PA; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Sonali M. Smith, The University of Chicago, Chicago, IL; and Brad S. Kahl, University of Wisconsin, Madison, WI
| | - Richard I Fisher
- Paul M. Barr and Jonathan W. Friedberg, University of Rochester, Rochester; Steven M. Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Hongli Li and Michael LeBlanc, SWOG Statistical Office, Seattle, WA; Catherine Spier, University of Arizona College of Medicine, Tucson, AZ; Daruka Mahadevan, Mansoor Ul Haq, and Bryan D. Huber, University of Tennessee Health Sciences Center, Memphis, TN; Christopher R. Flowers, Emory University, Atlanta, GA; Nina D. Wagner-Johnston and Nancy L. Bartlett, Washington University School of Medicine, St. Louis, MO; Richard I. Fisher, Temple University, Philadelphia, PA; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Sonali M. Smith, The University of Chicago, Chicago, IL; and Brad S. Kahl, University of Wisconsin, Madison, WI
| | - Bruce D Cheson
- Paul M. Barr and Jonathan W. Friedberg, University of Rochester, Rochester; Steven M. Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Hongli Li and Michael LeBlanc, SWOG Statistical Office, Seattle, WA; Catherine Spier, University of Arizona College of Medicine, Tucson, AZ; Daruka Mahadevan, Mansoor Ul Haq, and Bryan D. Huber, University of Tennessee Health Sciences Center, Memphis, TN; Christopher R. Flowers, Emory University, Atlanta, GA; Nina D. Wagner-Johnston and Nancy L. Bartlett, Washington University School of Medicine, St. Louis, MO; Richard I. Fisher, Temple University, Philadelphia, PA; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Sonali M. Smith, The University of Chicago, Chicago, IL; and Brad S. Kahl, University of Wisconsin, Madison, WI
| | - Sonali M Smith
- Paul M. Barr and Jonathan W. Friedberg, University of Rochester, Rochester; Steven M. Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Hongli Li and Michael LeBlanc, SWOG Statistical Office, Seattle, WA; Catherine Spier, University of Arizona College of Medicine, Tucson, AZ; Daruka Mahadevan, Mansoor Ul Haq, and Bryan D. Huber, University of Tennessee Health Sciences Center, Memphis, TN; Christopher R. Flowers, Emory University, Atlanta, GA; Nina D. Wagner-Johnston and Nancy L. Bartlett, Washington University School of Medicine, St. Louis, MO; Richard I. Fisher, Temple University, Philadelphia, PA; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Sonali M. Smith, The University of Chicago, Chicago, IL; and Brad S. Kahl, University of Wisconsin, Madison, WI
| | - Brad S Kahl
- Paul M. Barr and Jonathan W. Friedberg, University of Rochester, Rochester; Steven M. Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Hongli Li and Michael LeBlanc, SWOG Statistical Office, Seattle, WA; Catherine Spier, University of Arizona College of Medicine, Tucson, AZ; Daruka Mahadevan, Mansoor Ul Haq, and Bryan D. Huber, University of Tennessee Health Sciences Center, Memphis, TN; Christopher R. Flowers, Emory University, Atlanta, GA; Nina D. Wagner-Johnston and Nancy L. Bartlett, Washington University School of Medicine, St. Louis, MO; Richard I. Fisher, Temple University, Philadelphia, PA; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Sonali M. Smith, The University of Chicago, Chicago, IL; and Brad S. Kahl, University of Wisconsin, Madison, WI
| | - Nancy L Bartlett
- Paul M. Barr and Jonathan W. Friedberg, University of Rochester, Rochester; Steven M. Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Hongli Li and Michael LeBlanc, SWOG Statistical Office, Seattle, WA; Catherine Spier, University of Arizona College of Medicine, Tucson, AZ; Daruka Mahadevan, Mansoor Ul Haq, and Bryan D. Huber, University of Tennessee Health Sciences Center, Memphis, TN; Christopher R. Flowers, Emory University, Atlanta, GA; Nina D. Wagner-Johnston and Nancy L. Bartlett, Washington University School of Medicine, St. Louis, MO; Richard I. Fisher, Temple University, Philadelphia, PA; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Sonali M. Smith, The University of Chicago, Chicago, IL; and Brad S. Kahl, University of Wisconsin, Madison, WI
| | - Jonathan W Friedberg
- Paul M. Barr and Jonathan W. Friedberg, University of Rochester, Rochester; Steven M. Horwitz, Memorial Sloan Kettering Cancer Center, New York, NY; Hongli Li and Michael LeBlanc, SWOG Statistical Office, Seattle, WA; Catherine Spier, University of Arizona College of Medicine, Tucson, AZ; Daruka Mahadevan, Mansoor Ul Haq, and Bryan D. Huber, University of Tennessee Health Sciences Center, Memphis, TN; Christopher R. Flowers, Emory University, Atlanta, GA; Nina D. Wagner-Johnston and Nancy L. Bartlett, Washington University School of Medicine, St. Louis, MO; Richard I. Fisher, Temple University, Philadelphia, PA; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Sonali M. Smith, The University of Chicago, Chicago, IL; and Brad S. Kahl, University of Wisconsin, Madison, WI
| |
Collapse
|
285
|
Lee HZ, Kwitkowski VE, Del Valle PL, Ricci MS, Saber H, Habtemariam BA, Bullock J, Bloomquist E, Li Shen Y, Chen XH, Brown J, Mehrotra N, Dorff S, Charlab R, Kane RC, Kaminskas E, Justice R, Farrell AT, Pazdur R. FDA Approval: Belinostat for the Treatment of Patients with Relapsed or Refractory Peripheral T-cell Lymphoma. Clin Cancer Res 2015; 21:2666-70. [PMID: 25802282 DOI: 10.1158/1078-0432.ccr-14-3119] [Citation(s) in RCA: 250] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 03/02/2015] [Indexed: 11/16/2022]
Abstract
On July 3, 2014, the FDA granted accelerated approval for belinostat (Beleodaq; Spectrum Pharmaceuticals, Inc.), a histone deacetylase inhibitor, for the treatment of patients with relapsed or refractory peripheral T-cell lymphoma (PTCL). A single-arm, open-label, multicenter, international trial in the indicated patient population was submitted in support of the application. Belinostat was administered intravenously at a dose of 1000 mg/m(2) over 30 minutes once daily on days 1 to 5 of a 21-day cycle. The primary efficacy endpoint was overall response rate (ORR) based on central radiology readings by an independent review committee. The ORR was 25.8% [95% confidence interval (CI), 18.3-34.6] in 120 patients that had confirmed diagnoses of PTCL by the Central Pathology Review Group. The complete and partial response rates were 10.8% (95% CI, 5.9-17.8) and 15.0% (95% CI, 9.1-22.7), respectively. The median duration of response, the key secondary efficacy endpoint, was 8.4 months (95% CI, 4.5-29.4). The most common adverse reactions (>25%) were nausea, fatigue, pyrexia, anemia, and vomiting. Grade 3/4 toxicities (≥5.0%) included anemia, thrombocytopenia, dyspnea, neutropenia, fatigue, and pneumonia. Belinostat is the third drug to receive accelerated approval for the treatment of relapsed or refractory PTCL.
Collapse
Affiliation(s)
- Hyon-Zu Lee
- Office of Hematology and Oncology Products, Office of New Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland.
| | - Virginia E Kwitkowski
- Office of Hematology and Oncology Products, Office of New Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Pedro L Del Valle
- Office of Hematology and Oncology Products, Office of New Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - M Stacey Ricci
- Office of Hematology and Oncology Products, Office of New Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Haleh Saber
- Office of Hematology and Oncology Products, Office of New Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Bahru A Habtemariam
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Julie Bullock
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Erik Bloomquist
- Office of Biostatistics, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Yuan Li Shen
- Office of Biostatistics, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Xiao-Hong Chen
- Office of New Drug Quality Assessment, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Janice Brown
- Office of New Drug Quality Assessment, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Nitin Mehrotra
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Sarah Dorff
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Rosane Charlab
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Robert C Kane
- Office of Hematology and Oncology Products, Office of New Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Edvardas Kaminskas
- Office of Hematology and Oncology Products, Office of New Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Robert Justice
- Office of Hematology and Oncology Products, Office of New Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Ann T Farrell
- Office of Hematology and Oncology Products, Office of New Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Richard Pazdur
- Office of Hematology and Oncology Products, Office of New Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| |
Collapse
|
286
|
Reimer P. New developments in the treatment of peripheral T-cell lymphoma - role of Belinostat. Cancer Manag Res 2015; 7:145-51. [PMID: 26082661 PMCID: PMC4461120 DOI: 10.2147/cmar.s85351] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Peripheral T-cell lymphomas (PTCL) represent a heterogeneous group of rare malignancies that with the exception of anaplastic lymphoma kinase expressing anaplastic large cell lymphoma, share a poor outcome after standard (eg, anthracycline-based) chemotherapy. Most patients are either refractory to initial therapy or eventually relapse. Randomized studies for relapsed/refractory PTCL are not available, however, recently published data show that conventional chemotherapy has very limited efficacy in the salvage setting. Thus, novel drugs are urgently needed to improve the outcome in this setting. Belinostat, a pan-histone deacetylase inhibitor, has demonstrated meaningful efficacy and a favorable toxicity profile in two single-arm Phase II trials on 153 patients with relapsed/refractory PTCL. The conclusive results led to an accelerated approval by the US Food and Drug Administration. The present review summarizes the clinical data available for belinostat, its current role, and future perspectives.
Collapse
Affiliation(s)
- Peter Reimer
- Clinic for Hematology, Medical Oncology and Stem Cell Transplantation, Evangelisches Krankenhaus Essen-Werden gGmbH, Essen, Germany
| |
Collapse
|
287
|
Central nervous system relapse in peripheral T-cell lymphomas: a Swedish Lymphoma Registry study. Blood 2015; 126:36-41. [PMID: 25957393 DOI: 10.1182/blood-2014-12-616961] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 05/07/2015] [Indexed: 11/20/2022] Open
Abstract
Central nervous system (CNS) relapse in non-Hodgkin lymphoma (NHL) carries a very poor prognosis. Risk factors and outcome have been studied in aggressive B-cell lymphomas, but very little is known about the risk in peripheral T-cell lymphoma (PTCL). We aimed at analyzing risk factors for CNS involvement at first relapse or progression, as well as the outcome of these patients, in a large population-based cohort of patients with PTCL. Twenty-eight out of 625 patients (4.5%) developed CNS disease over time. In multivariable analysis, disease characteristics at diagnosis independently associated with an increased risk for later CNS involvement were involvement of more than 1 extranodal site (hazard ratio [HR], 2.60; 95% confidence interval [CI], 1.07-6.29; P = .035) and skin (HR, 3.51; 95% CI, 1.26-9.74; P = .016) and gastrointestinal involvement (HR, 3.06; 95% CI, 1.30-7.18; P = .010). The outcome of relapsed/refractory patients was very poor, and CNS involvement was not associated with a significantly worse outcome compared with relapsed/refractory patients without CNS involvement in multivariable analysis (HR, 1.6; 95% CI, 0.96-2.6; P = .074). The results from the present study indicate that CNS relapse in PTCL occurs at a frequency similar to what is seen in aggressive B-cell lymphomas, but the poor outcomes in relapse are largely driven by systemic rather than CNS disease.
Collapse
|
288
|
Horwitz S, Coiffier B, Foss F, Prince HM, Sokol L, Greenwood M, Caballero D, Morschhauser F, Pinter-Brown L, Iyer SP, Shustov A, Nichols J, Balser J, Balser B, Pro B. Utility of ¹⁸fluoro-deoxyglucose positron emission tomography for prognosis and response assessments in a phase 2 study of romidepsin in patients with relapsed or refractory peripheral T-cell lymphoma. Ann Oncol 2015; 26:774-779. [PMID: 25605745 PMCID: PMC4374388 DOI: 10.1093/annonc/mdv010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 12/19/2014] [Accepted: 12/23/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND For patients with peripheral T-cell lymphoma (PTCL), the value of (18)fluoro-deoxyglucose positron emission tomography (FDG-PET) scans for assessing prognosis and response to treatment remains unclear. The utility of FDG-PET, in addition to conventional radiology, was examined as a planned exploratory end point in the pivotal phase 2 trial of romidepsin for the treatment of relapsed/refractory PTCL. PATIENTS AND METHODS Patients received romidepsin at a dose of 14 mg/m(2) on days 1, 8, and 15 of 28-day cycles. The primary end point was the rate of confirmed/unconfirmed complete response (CR/CRu) as assessed by International Workshop Criteria (IWC) using conventional radiology. For the exploratory PET end point, patients with at least baseline FDG-PET scans were assessed by IWC + PET criteria. RESULTS Of 130 patients, 110 had baseline FDG-PET scans, and 105 were PET positive at baseline. The use of IWC + PET criteria increased the objective response rate to 30% compared with 26% by conventional radiology. Durations of response were well differentiated by both conventional radiology response criteria [CR/CRu versus partial response (PR), P = 0.0001] and PET status (negative versus positive, P < 0.0001). Patients who achieved CR/CRu had prolonged progression-free survival (PFS, median 25.9 months) compared with other response groups (P = 0.0007). Patients who achieved PR or stable disease (SD) had similar PFS (median 7.2 and 6.3 months, respectively, P = 0.6427). When grouping PR and SD patients by PET status, patients with PET-negative versus PET-positive disease had a median PFS of 18.2 versus 7.1 months (P = 0.0923). CONCLUSIONS Routine use of FDG-PET does not obviate conventional staging, but may aid in determining prognosis and refine response assessments for patients with PTCL, particularly for those who do not achieve CR/CRu by conventional staging. The optimal way to incorporate FDG-PET scans for patients with PTCL remains to be determined. TRIAL REGISTRATION NCT00426764.
Collapse
MESH Headings
- Antibiotics, Antineoplastic/therapeutic use
- Depsipeptides/therapeutic use
- Drug Resistance, Neoplasm/drug effects
- Fluorodeoxyglucose F18/pharmacokinetics
- Follow-Up Studies
- Humans
- Lymphoma, T-Cell, Peripheral/diagnostic imaging
- Lymphoma, T-Cell, Peripheral/drug therapy
- Lymphoma, T-Cell, Peripheral/mortality
- Lymphoma, T-Cell, Peripheral/pathology
- Neoplasm Staging
- Positron-Emission Tomography/statistics & numerical data
- Prognosis
- Prospective Studies
- Radiopharmaceuticals/pharmacokinetics
- Remission Induction
- Survival Rate
- Tissue Distribution
Collapse
Affiliation(s)
- S Horwitz
- Lymphoma Division, Memorial Sloan-Kettering Cancer Center, New York, USA.
| | - B Coiffier
- Department of Hematology, Hospices Civils de Lyon, Lyon, France
| | - F Foss
- Hematology Department, Yale Cancer Center, New Haven, USA
| | - H M Prince
- Division of Cancer Medicine, Department of Haematology, Peter MacCallum Cancer Centre and University of Melbourne, Australia
| | - L Sokol
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, USA
| | - M Greenwood
- Department of Haematology, Royal North Shore Hospital, Sydney, Australia
| | - D Caballero
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - F Morschhauser
- Department of Hematology, Hôpital Claude Huriez, CHU de Lille, France
| | - L Pinter-Brown
- Division of Hematology-Oncology, UCLA Medical Center, Los Angeles
| | - S P Iyer
- Malignant Hematology, Houston Methodist Cancer Center, Houston
| | - A Shustov
- Division of Hematology, University of Washington, Seattle
| | | | | | | | - B Pro
- Division of Hematology, Thomas Jefferson University, Philadelphia, USA
| |
Collapse
|
289
|
Hematopoietic stem cell transplantation in nodal T cell non-hodgkin lymphomas: revisiting the issues. Biol Blood Marrow Transplant 2015; 21:777-9. [PMID: 25783633 DOI: 10.1016/j.bbmt.2015.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 03/11/2015] [Indexed: 11/23/2022]
|
290
|
Dupuis J, Morschhauser F, Ghesquières H, Tilly H, Casasnovas O, Thieblemont C, Ribrag V, Bossard C, Le Bras F, Bachy E, Hivert B, Nicolas-Virelizier E, Jardin F, Bastie JN, Amorim S, Lazarovici J, Martin A, Coiffier B. 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 HAEMATOLOGY 2015; 2:e160-5. [PMID: 26687958 DOI: 10.1016/s2352-3026(15)00023-x] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/12/2015] [Accepted: 02/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Romidepsin is a histone deacetylase inhibitor approved in the USA for patients with recurrent or refractory peripheral T-cell lymphoma and has shown activity in this setting with mainly haematological and gastrointestinal toxicity. Although it has limited efficacy, cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) therapy is widely used for treatment of de-novo peripheral T-cell lymphoma. We aimed to assess the safety, tolerability, and activity of romidepsin combined with CHOP in patients with previously untreated disease. METHODS We enrolled patients aged 18-80 years with histologically proven, previously untreated, peripheral T-cell lymphoma (Eastern Cooperative Oncology Group performance status ≤2) into a dose-escalation (phase 1b) and expansion (phase 2) study at nine Lymphoma Study Association centres in France. In the dose-escalation phase, we allocated consecutive blocks of three participants to receive eight 3 week cycles of CHOP (intravenous cyclophosphamide 750 mg/m(2), doxorubicin 50 mg/m(2), and vincristine 1.4 mg/m(2) [maximum 2 mg] on day 1 and oral prednisone 40 mg/m(2) on days 1-5) in association with varying doses of romidepsin. The starting dose was 10 mg/m(2) intravenously on days 1 and 8 of each cycle, and we used a 3 + 3 design. We assessed dose-limiting toxicities only during the first two cycles. The primary endpoint was to determine the recommended dose for the combination. For the phase 2 study, we aimed to increase the cohort of patients receiving the recommended dose to a total of 25 patients. Patients were assessed for safety outcomes at least twice per cycle according to the Common Terminology Criteria for Adverse Events, version 4.0. Safety analyses included all patients who received at least one dose of romidepsin and CHOP. This trial is registered at the European Clinical Trials Database (EudraCT), number 2010-020962-91 and ClinicalTrials.gov, number NCT01280526. FINDINGS Between Jan 13, 2011, and May 21, 2013, we enrolled 37 patients (18 treated in phase 1b and 19 patients in phase 2). Three of six patients initially treated at 10 mg/m(2) had a dose-limiting toxicity. The dose-escalation committee decided to modify the study protocol to redefine dose-limiting toxicities with regard to haematological toxicity. Three patients were treated with 8 mg/m(2) of romidepsin, an additional three at 10 mg/m(2) (one dose-limiting toxicity), and six patients at 12 mg/m(2) (three dose-limiting toxicities). We chose romidepsin 12 mg/m(2) as the recommended dose for phase 2. Of the 37 patients treated, three had early cardiac events (two myocardial infarctions and one acute cardiac failure). No deaths were attributable to toxicity. 25 (68%) of 37 patients had at least one serious adverse event. Overall, the most frequent serious adverse events were febrile neutropenia (five [14%] of 37 patients), physical health deterioration (five [14%]), lung infection (four [11%]), and vomiting (three [8%]). 33 (89%) of patients had grade 3-4 neutropenia, and 29 (78%) had grade 3-4 thrombocytopenia. INTERPRETATION Romidepsin can be combined with CHOP but this combination should now be tested in comparison to CHOP alone in a randomised trial. FUNDING Celgene.
Collapse
Affiliation(s)
- Jehan Dupuis
- Lymphoid Malignancies Unit, Henri Mondor University Hospital, Créteil, France
| | - Franck Morschhauser
- Department of Hematology, GRITA Unit, Claude Huriez University Hospital, Lille, France
| | | | - Hervé Tilly
- Department of Hematology, Henri Becquerel Cancer Center, Rouen, France
| | | | | | - Vincent Ribrag
- Department of Hematology, Gustave Roussy Cancer Center, Villejuif, France
| | - Céline Bossard
- Department of Pathology, Hôtel Dieu University Hospital, Nantes, France
| | - Fabien Le Bras
- Lymphoid Malignancies Unit, Henri Mondor University Hospital, Créteil, France
| | - Emmanuel Bachy
- Department of Hematology, Hospices Civils de Lyon and University Lyon 1, Lyon, France
| | - Bénédicte Hivert
- Department of Hematology, GRITA Unit, Claude Huriez University Hospital, Lille, France
| | | | - Fabrice Jardin
- Department of Hematology, Henri Becquerel Cancer Center, Rouen, France
| | | | - Sandy Amorim
- Department of Hematology-Oncology, Saint Louis Hospital, Paris, France
| | - Julien Lazarovici
- Department of Hematology, Gustave Roussy Cancer Center, Villejuif, France
| | - Antoine Martin
- Department of Pathology, Avicenne University Hospital, Bobigny, France
| | - Bertrand Coiffier
- Department of Hematology, Hospices Civils de Lyon and University Lyon 1, Lyon, France.
| |
Collapse
|
291
|
Macalalad AR, McAuliffe M, Yang H, Kageleiry A, Zhong Y, Wu EQ, Shonukan O, Bonthapally V. The epidemiology and targeted therapies for relapsed and refractory CD30+ lymphomas. Curr Med Res Opin 2015; 31:537-45. [PMID: 25598441 DOI: 10.1185/03007995.2015.1008131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hodgkin lymphoma (HL) and systemic anaplastic large cell lymphoma (sALCL) both have consistent expression of CD30, a cytokine receptor that is expressed by activated T and B cells but is largely absent from normal tissue. METHODS A literature search was conducted via PubMed, Google Scholar, and UpToDate to identify relevant peer-reviewed original research or review articles on HL, sALCL, and CD30 targeted therapies. RESULTS These lymphomas are both more common among males, young adults and the elderly. Although many patients with HL and sALCL can achieve long-term remission after standard first-line therapy, up to a third of these patients are refractory to or relapse after initial therapy. Among these relapsed/refractory patients, many experience disease progression and/or death despite subsequent treatment, and treatment-related adverse events and mortality are not uncommon. To address the need for safer and more effective therapies for these relapsed/refractory patients, researchers have developed therapies that specifically target CD30-expressing cells. Brentuximab vedotin, an antibody-drug conjugate that selectively delivers a toxic microtubule-disrupting agent to malignant cells with CD30 expression, is the first such therapy to be approved in the US and Europe. In clinical trials, brentuximab vedotin has demonstrated efficacy and safety in patients with HL after failure of autologous stem cell transplantation (ASCT), or after failure of at least two prior multi-agent chemotherapy regimens in patients who are not ASCT candidates, and in patients with sALCL after failure of at least one prior multi-agent chemotherapy regimen. CONCLUSION HL and sALCL are both CD30+ lymphomas, and therapies like brentuximab vedotin that target cells expressing CD30 hold promise for the treatment of these diseases.
Collapse
|
292
|
Beitinjaneh A, Saliba RM, Medeiros LJ, Turturro F, Rondon G, Korbling M, Fayad L, Fanale MA, Alousi AM, Anderlini P, Betul O, Popat UR, Pro B, Khouri IF. Comparison of survival in patients with T cell lymphoma after autologous and allogeneic stem cell transplantation as a frontline strategy or in relapsed disease. Biol Blood Marrow Transplant 2015; 21:855-9. [PMID: 25652691 DOI: 10.1016/j.bbmt.2015.01.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 01/13/2015] [Indexed: 01/08/2023]
Abstract
We studied the roles of autologous (A) and allogeneic (allo) stem cell transplantation (SCT) in the treatment of 134 patients with T cell lymphoma (TCL) at our center. For frontline SCT, 58 patients were studied. The 4-year overall survival (OS) rates for ASCT (n = 47; median age, 49 years) and alloSCT (n = 11; median age, 55 years) groups were 76% and 54%, respectively (P > .05). The 4-year OS rates for first complete remission (CR1) patients were 84% and 83%, respectively. For SCT for relapsed disease, 76 patients were studied (41 with ASCT and 35 with alloSCT). The 4-year OS rates were 50% and 36% for ASCT and alloSCT patients with chemosensitive disease, respectively (P > .05). Those who were in CR2 and CR3 had 4-year OS rates of 59% and 53%, respectively. Similar results were also observed in patients with refractory disease (29% and 35%, respectively). These data suggest that a pre-SCT CR is associated with improved outcomes in TCL patients after SCT. Considering the 84% 4-year OS rates in CR1 patients and the unpredictable responses in patients with relapsed disease, we favor the use of ASCT as consolidation therapy after CR1. AlloSCT did not result in a superior outcome compared with ASCT.
Collapse
Affiliation(s)
- Amer Beitinjaneh
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rima M Saliba
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - L Jeffrey Medeiros
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Francesco Turturro
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gabriela Rondon
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Martin Korbling
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Luis Fayad
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michelle A Fanale
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amin M Alousi
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Paolo Anderlini
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Oran Betul
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Uday R Popat
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Barbara Pro
- Department of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Kimmel Cancer Center, Philadelphia, Pennsylvania
| | - Issa F Khouri
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas.
| |
Collapse
|
293
|
Abstract
T-cell lymphomas are a biologically and clinically diverse collection of diseases that collectively account for 10% to 15% of non-Hodgkin lymphomas. Unlike B-cell lymphomas, the response of T-cell lymphomas to standard anthracycline-containing chemotherapy regimens is suboptimal and the prognosis of patients is accordingly poor. To address these shortcomings, there has been a proliferation in biologic agents with novel mechanisms of action that target surface antigens, signaling pathways, or cellular processes. Given the large number of candidate molecules showing preclinical promise and the rarity of these diseases, drug development for peripheral T-cell lymphoma is challenging. We provide an overview of agents that have recently been approved for relapsed/refractory T-cell lymphoma and highlight efforts to introduce these agents into front-line treatment protocols in combination with chemotherapy. We discuss biologic doublets currently being evaluated as "chemotherapy-free" salvage regimens and highlight some of the most promising investigational agents in early clinical development.
Collapse
Affiliation(s)
- Chan Yoon Cheah
- From the Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yasuhiro Oki
- From the Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michelle A Fanale
- From the Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
294
|
Abstract
High-dose chemotherapy followed by transplantation of autologous hematopoietic progenitor cells has a proven track record of safety and efficacy in hematological malignancies and select solid tumors. The near-universal use of peripheral blood stem cells as source for autografts, routine growth factor support, and antimicrobial prophylaxis post transplantation has improved the safety of this procedure. However, the advent of highly active novel therapies in the last few years warrants reappraisal of the role of autologous transplantation in the therapeutic armamentarium of malignant disorder. This review summarizes the current role of autologous transplantation for hematological malignancies, discusses modern standards for patient selection, and highlights long-term care issues of transplant survivors from an internist's perspective. Role of tumor purging in autologous transplantation, novel transplant conditioning regimens, and post-transplant therapies to prevent disease relapse are reviewed.
Collapse
Affiliation(s)
- Mehdi Hamadani
- Division of Hematology & Oncology, Medical College of Wisconsin , Milwaukee, WI , USA
| |
Collapse
|
295
|
Martín-Sánchez E, Odqvist L, Rodríguez-Pinilla SM, Sánchez-Beato M, Roncador G, Domínguez-González B, Blanco-Aparicio C, García Collazo AM, Cantalapiedra EG, Fernández JP, del Olmo SC, Pisonero H, Madureira R, Almaraz C, Mollejo M, Alves FJ, Menárguez J, González-Palacios F, Rodríguez-Peralto JL, Ortiz-Romero PL, Real FX, García JF, Bischoff JR, Piris MA. PIM kinases as potential therapeutic targets in a subset of peripheral T cell lymphoma cases. PLoS One 2014; 9:e112148. [PMID: 25386922 PMCID: PMC4227704 DOI: 10.1371/journal.pone.0112148] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 10/13/2014] [Indexed: 01/18/2023] Open
Abstract
Currently, there is no efficient therapy for patients with peripheral T cell lymphoma (PTCL). The Proviral Integration site of Moloney murine leukemia virus (PIM) kinases are important mediators of cell survival. We aimed to determine the therapeutic value of PIM kinases because they are overexpressed in PTCL patients, T cell lines and primary tumoral T cells. PIM kinases were inhibited genetically (using small interfering and short hairpin RNAs) and pharmacologically (mainly with the pan-PIM inhibitor (PIMi) ETP-39010) in a panel of 8 PTCL cell lines. Effects on cell viability, apoptosis, cell cycle, key proteins and gene expression were evaluated. Individual inhibition of each of the PIM genes did not affect PTCL cell survival, partially because of a compensatory mechanism among the three PIM genes. In contrast, pharmacological inhibition of all PIM kinases strongly induced apoptosis in all PTCL cell lines, without cell cycle arrest, in part through the induction of DNA damage. Therefore, pan-PIMi synergized with Cisplatin. Importantly, pharmacological inhibition of PIM reduced primary tumoral T cell viability without affecting normal T cells ex vivo. Since anaplastic large cell lymphoma (ALK+ ALCL) cell lines were the most sensitive to the pan-PIMi, we tested the simultaneous inhibition of ALK and PIM kinases and found a strong synergistic effect in ALK+ ALCL cell lines. Our findings suggest that PIM kinase inhibition could be of therapeutic value in a subset of PTCL, especially when combined with ALK inhibitors, and might be clinically beneficial in ALK+ ALCL.
Collapse
Affiliation(s)
- Esperanza Martín-Sánchez
- Molecular Pathology Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- Cancer Genomics Group, Marqués de Valdecilla Research Institute (IDIVAL) & Pathology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Lina Odqvist
- Molecular Pathology Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | | | - Margarita Sánchez-Beato
- Onco-hematology Area, Instituto de Investigación Sanitaria Hospital Universitario Puerta de Hierro - Majadahonda, Madrid, Spain
| | - Giovanna Roncador
- Monoclonal Antibodies Core Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | | | - Carmen Blanco-Aparicio
- Experimental Therapeutics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Ana M. García Collazo
- Experimental Therapeutics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | | | - Joaquín Pastor Fernández
- Experimental Therapeutics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Soraya Curiel del Olmo
- Cancer Genomics Group, Marqués de Valdecilla Research Institute (IDIVAL) & Pathology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Helena Pisonero
- Cancer Genomics Group, Marqués de Valdecilla Research Institute (IDIVAL) & Pathology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Rebeca Madureira
- Cancer Genomics Group, Marqués de Valdecilla Research Institute (IDIVAL) & Pathology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Carmen Almaraz
- Cancer Genomics Group, Marqués de Valdecilla Research Institute (IDIVAL) & Pathology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Manuela Mollejo
- Pathology Department, Hospital Virgen de la Salud, Toledo, Spain
| | | | | | | | - José Luis Rodríguez-Peralto
- Pathology Department, 12 de Octubre University Hospital, Medical School Universidad Complutense, Instituto i+12, Madrid, Spain
| | - Pablo L. Ortiz-Romero
- Dermatology Department, 12 de Octubre University Hospital, Medical School Universidad Complutense, Instituto i+12, Madrid, Spain
| | - Francisco X. Real
- Molecular Pathology Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Juan F. García
- Translational Research Laboratory, M. D. Anderson Cancer Center Madrid, Madrid, Spain
| | - James R. Bischoff
- Experimental Therapeutics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Miguel A. Piris
- Molecular Pathology Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- Cancer Genomics Group, Marqués de Valdecilla Research Institute (IDIVAL) & Pathology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
- * E-mail:
| |
Collapse
|
296
|
Pathogenetic and diagnostic significance of microRNA deregulation in peripheral T-cell lymphoma not otherwise specified. Blood Cancer J 2014; 4:259. [PMID: 25382608 PMCID: PMC4335255 DOI: 10.1038/bcj.2014.78] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 09/18/2014] [Indexed: 12/14/2022] Open
Abstract
Peripheral T-cell lymphomas not otherwise specified (PTCLs/NOS) are rare and aggressive tumours whose molecular pathogenesis and diagnosis are still challenging. The microRNA (miRNA) profile of 23 PTCLs/NOS was generated and compared with that of normal T-lymphocytes (CD4+, CD8+, naive, activated). The differentially expressed miRNA signature was compared with the gene expression profile (GEP) of the same neoplasms. The obtained gene patterns were tested in an independent cohort of PTCLs/NOS. The miRNA profile of PTCLs/NOS then was compared with that of 10 angioimmunoblastic T-cell lymphomas (AITLs), 6 anaplastic large-cell lymphomas (ALCLs)/ALK+ and 6 ALCLs/ALK−. Differentially expressed miRNAs were validated in an independent set of 20 PTCLs/NOS, 20 AITLs, 19 ALCLs/ALK− and 15 ALCLs/ALK+. Two hundred and thirty-six miRNAs were found to differentiate PTCLs/NOS from activated T-lymphocytes. To assess which miRNAs impacted on GEP, a multistep analysis was performed, which identified all miRNAs inversely correlated to different potential target genes. One of the most discriminant miRNAs was selected and its expression was found to affect the global GEP of the tumours. Moreover, two sets of miRNAs were identified distinguishing PTCL/NOS from AITL and ALCL/ALK−, respectively. The diagnostic accuracy of this tool was very high (83.54%) and its prognostic value validated.
Collapse
|
297
|
Briski R, Feldman AL, Bailey NG, Lim MS, Ristow K, Habermann TM, Macon WR, Inwards DJ, Colgan JP, Nowakowski GS, Kaminski MS, Witzig TE, Ansell SM, Wilcox RA. Survival in patients with limited-stage peripheral T-cell lymphomas. Leuk Lymphoma 2014; 56:1665-70. [PMID: 25248884 DOI: 10.3109/10428194.2014.963078] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The natural history of limited-stage peripheral T-cell lymphoma (PTCL) remains poorly defined. Therefore, we examined outcomes in patients with the most common PTCL subtypes (PTCL, not otherwise specified [PTCL, NOS], angioimmunoblastic T-cell lymphoma [AITL], anaplastic large cell lymphoma [ALCL]) and limited-stage disease. In this retrospective, multicenter study, 75 patients with limited-stage disease were identified. The median event-free survival (EFS) and overall survival (OS) observed were 2.1 and 6.5 years, respectively. In a landmark analysis excluding patients with primary refractory disease, no significant benefit was observed for patients undergoing consolidative radiation therapy. With the exception of patients undergoing salvage hematopoietic stem cell transplant, survival following disease relapse or progression was poor, thus highlighting the need for improved therapeutic strategies.
Collapse
Affiliation(s)
- Robert Briski
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan , Ann Arbor, MI , USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
298
|
Toumishey E, Prasad A, Dueck G, Chua N, Finch D, Johnston J, van der Jagt R, Stewart D, White D, Belch A, Reiman T. Final report of a phase 2 clinical trial of lenalidomide monotherapy for patients with T-cell lymphoma. Cancer 2014; 121:716-23. [DOI: 10.1002/cncr.29103] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/17/2014] [Accepted: 09/15/2014] [Indexed: 12/24/2022]
Affiliation(s)
- Ethan Toumishey
- Department of Medicine; Dalhousie University; Saint John New Brunswick Canada
| | - Angeli Prasad
- Department of Oncology; University of Alberta; Edmonton Alberta Canada
| | - Greg Dueck
- Medical Oncology; British Columbia Cancer Agency, Centre for the Southern Interior; Kelowna British Columbia Canada
| | - Neil Chua
- Department of Oncology; University of Alberta; Edmonton Alberta Canada
| | - Daygen Finch
- Medical Oncology; British Columbia Cancer Agency, Centre for the Southern Interior; Kelowna British Columbia Canada
| | - James Johnston
- Department of Medicine; University of Manitoba; Winnipeg Manitoba Canada
| | | | - Doug Stewart
- Department of Medicine; University of Calgary; Calgary Alberta Canada
| | - Darrell White
- Department of Medicine; Dalhousie University; Halifax Nova Scotia Canada
| | - Andrew Belch
- Department of Oncology; University of Alberta; Edmonton Alberta Canada
| | - Tony Reiman
- Department of Medicine; Dalhousie University; Saint John New Brunswick Canada
- Canadian Cancer Society Research Chair; University of New Brunswick; Fredericton New Brunswick Canada
| |
Collapse
|
299
|
Reimer P. Treatment options for patients with relapsing and refractory peripheral T-cell lymphoma. Int J Hematol Oncol 2014. [DOI: 10.2217/ijh.14.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Peripheral T-cell lymphomas are rare malignancies that with the exception of ALK-expressing anaplastic large cell lymphoma show a poor outcome after conventional (anthracycline-based) chemotherapy. The median overall survival ranges between approximately 9–42 months. Most patients are refractory or relapsing, and need salvage treatment. Several strategies have been investigated for this setting, but data are sparse. Autologous and allogeneic stem cell transplantation can induce long-term remissions and cure in a subset of chemosensitive patients. In addition, novel agents are available and under investigation to improve the outcome in this challenging group of diseases.
Collapse
|
300
|
Lin X, Shi X, Zeng W, Zheng M, Huang L. Salvage therapy with mitoxantrone, etoposide, bleomycin and dexamethasone for refractory or relapsed aggressive non-Hodgkin's lymphoma patients with a poor performance status or comorbidity. Oncol Lett 2014; 8:2012-2016. [PMID: 25295084 PMCID: PMC4186623 DOI: 10.3892/ol.2014.2517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 08/07/2014] [Indexed: 12/21/2022] Open
Abstract
The treatment of refractory or relapsed aggressive non-Hodgkin's lymphoma (NHL) in patients in a state of poor health is difficult due to their ineligibility to receive intensive salvage chemotherapy. In the present study, 16 refractory or relapsed aggressive NHL patients with a poor performance status or comorbidities were treated with mitoxantrone, etoposide, bleomycin and dexamethasone (MEBD) therapy. The treatment consisted of 10 mg/m2 intravenous (IV) mitoxantrone on day 1, 75 mg/m2 IV etoposide on days 1-3, 20 mg IV dexamethasone on days 1-4 and 15 mg intramuscular bleomycin on days 1, 4, 8 and 12, every 21 days. The efficacy and toxicity of the regimen were evaluated. The overall response rate was 68.8%, with a complete response rate of 18.8% and a partial response rate of 50.0%. The efficacy of the treatment for B-cell lymphoma was greater than that for T-cell lymphoma. The median progression-free survival time for the patients was 16.7 months and the median overall survival time was 22.4 months. The one-year overall survival rate was 62.5% and the two-year overall survival rate was 43.8%. The most common toxicity symptom was myelosuppression. In conclusion, refractory or relapsed aggressive NHL patients with a poor performance status or comorbidity are eligible for chemotherapy. MEBD therapy is an effective and feasible salvage regimen for NHL patients in a state of poor health.
Collapse
Affiliation(s)
- Xuede Lin
- Department of Chemotherapy, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Xi Shi
- Department of Chemotherapy, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Wucha Zeng
- Department of Chemotherapy, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Min Zheng
- Department of Chemotherapy, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Liming Huang
- Department of Chemotherapy, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| |
Collapse
|