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Kim YH, Prince HM, Whittaker S, Horwitz SM, Duvic M, Bechter O, Sanches JA, Stadler R, Scarisbrick J, Quaglino P, Zinzani PL, Wolter P, Eradat H, Pinter-Brown LC, Ortiz-Romero PL, Akilov OE, Trotman J, Taylor K, Weichenthal M, Walewski J, Fisher D, McNeeley M, Gru AA, Brown L, Palanca-Wessels MC, Lisano J, Onsum M, Bunn V, Little M, Trepicchio WL, Dummer R. Response to brentuximab vedotin versus physician's choice by CD30 expression and large cell transformation status in patients with mycosis fungoides: An ALCANZA sub-analysis. Eur J Cancer 2021; 148:411-421. [PMID: 33794441 PMCID: PMC9347228 DOI: 10.1016/j.ejca.2021.01.054] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/15/2021] [Accepted: 01/28/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Mycosis fungoides (MF), the most common type of cutaneous T-cell lymphoma, can lead to disfiguring lesions, debilitating pruritus and frequent skin infections. This study assessed response to brentuximab vedotin in patients with MF in the phase III ALCANZA study. METHODS Baseline CD30 levels and large-cell transformation (LCT) status were centrally reviewed in patients with previously-treated CD30-positive MF using ≥2 skin biopsies obtained at screening; eligible patients required ≥1 biopsy with ≥10% CD30 expression. Patients were categorised as CD30min < 10% (≥1 biopsy with <10% CD30 expression), or CD30min ≥ 10% (all biopsies with ≥10% CD30 expression) and baseline LCT present or absent. Efficacy analyses were the proportion of patients with objective response lasting ≥4 months (ORR4) and progression-free survival (PFS). RESULTS Clinical activity with brentuximab vedotin was observed across all CD30 expression levels in patients with ≥1 biopsy showing ≥10% CD30 expression. Superior ORR4 was observed with brentuximab vedotin versus physician's choice in patients: with CD30min < 10% (40.9% versus 9.5%), with CD30min ≥ 10% (57.1% versus 10.3%), with LCT (64.7% versus 17.6%) and without LCT (38.7% versus 6.5%). Brentuximab vedotin improved median PFS versus physician's choice in patients: with CD30min < 10% (16.7 versus 2.3 months), with CD30min ≥ 10% (15.5 versus 3.9 months), with LCT (15.5 versus 2.8 months) and without LCT (16.1 versus 3.5 months). Safety profiles were generally comparable across subgroups. CONCLUSION These exploratory analyses demonstrated that brentuximab vedotin improved rates of ORR4 and PFS versus physician's choice in patients with CD30-positive MF and ≥1 biopsy showing ≥10% CD30 expression, regardless of LCT status. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov, NCT01578499.
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Affiliation(s)
- Youn H Kim
- Dermatology and Medicine, Stanford University School of Medicine and Cancer Institute, 780 Welch Road, CJ220D, 94305, Stanford, CA, USA.
| | - H Miles Prince
- Department of Haematology, University of Melbourne, 140 Clarendon Street, 3002, East Melbourne, Australia.
| | - Sean Whittaker
- St Johns Institute of Dermatology, Guys and St Thomas NHS Foundation Trust, St Thomas Street, SE1 7EL, London, UK.
| | - Steven M Horwitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, 10065, New York, NY, USA.
| | - Madeleine Duvic
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1452, 77030, Houston, TX, USA.
| | - Oliver Bechter
- Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Jose A Sanches
- Department of Dermatology, University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar 255, S. 3068, 05403-000, São Paulo, Brazil.
| | - Rudolf Stadler
- University Clinic for Dermatology, Johannes Wesling Medical Centre, Hans-Nolte-Str. 1, D-32429, Minden, Germany.
| | - Julia Scarisbrick
- Department of Dermatology, Cutaneous Lymphoma Service, University Hospital Birmingham, Mindelsohn Way, B15 2TH, Birmingham, UK.
| | - Pietro Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Via Cherasco 23, 10126, Turin, Italy.
| | - Pier Luigi Zinzani
- Institute of Hematology 'Seràgnoli', University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
| | - Pascal Wolter
- Department of Internal Medicine/Medical Oncology, Klinik St. Josef, St Vith, Klosterstrasse 9, 4780, St Vith, Belgium.
| | - Herbert Eradat
- Department of Hematology-Oncology, David Geffen School of Medicine at UCLA, 2020 Santa Monica Blvd Suite 600, 90404, Los Angeles, CA, USA.
| | - Lauren C Pinter-Brown
- Internal Medicine, Division of Hematology-Oncology, Chao Family Comprehensive Cancer Center, University of California, 101 The City Drive, 92868, Irvine, CA, USA.
| | - Pablo L Ortiz-Romero
- Department of Dermatology, Hospital 12 de Octubre. Institute I+12. Medical School. University Complutense, Av Córdoba s/n, 28041, Madrid, Spain.
| | - Oleg E Akilov
- Department of Dermatology, University of Pittsburgh, 200 Lothrop Street, 15213, Pittsburgh, PA, USA.
| | - Judith Trotman
- Department of Hematology, Concord Repatriation General Hospital, University of Sydney, Hospital Road, 2139, Concord, Sydney, Australia.
| | - Kerry Taylor
- Department of Hematology, ICON Cancer Care, 293 Vulture Street, 4101, South Brisbane, Australia.
| | - Michael Weichenthal
- Department of Dermatology, University Hospital of Schleswig-Holstein, Arnold Heller Str.3, 24105, Kiel, Germany.
| | - Jan Walewski
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, 5 W. K. Roentgen, 02-781, Warsaw, Poland.
| | - David Fisher
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, 02215, Boston, MA, USA.
| | - Marise McNeeley
- Department of Anatomic Pathology for Clinical Trials, Quest Diagnostics, 1 Malcolm Avenue, 07608, Teterboro, NJ, USA.
| | - Alejandro A Gru
- Department of Pathology, University of Virginia, School of Medicine, 2730 Hunt Country Ln, 22901, Charlottesville, VA, USA.
| | - Lisa Brown
- Seagen Inc, 21823 30th Drive Southeast, 98021, Bothell, WA, USA.
| | | | - Julie Lisano
- Seagen Inc, 21823 30th Drive Southeast, 98021, Bothell, WA, USA.
| | - Matthew Onsum
- Seagen Inc, 21823 30th Drive Southeast, 98021, Bothell, WA, USA.
| | - Veronica Bunn
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, 40 Landsdowne Street, 02139, Cambridge, MA, USA.
| | - Meredith Little
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, 40 Landsdowne Street, 02139, Cambridge, MA, USA.
| | - William L Trepicchio
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, 40 Landsdowne Street, 02139, Cambridge, MA, USA.
| | - Reinhard Dummer
- Department of Dermatology, Skin Cancer Center, University Hospital Zürich, Gloriastrasse 31, 8091, Zürich, Switzerland.
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Lansigan F, Horwitz SM, Pinter-Brown LC, Carson KR, Shustov AR, Rosen ST, Pro B, Hsi ED, Federico M, Gisselbrecht C, Schwartz M, Bellm LA, Acosta M, Foss FM. Outcomes of Patients with Transformed Mycosis Fungoides: Analysis from a Prospective Multicenter US Cohort Study. Clin Lymphoma Myeloma Leuk 2020; 20:744-748. [PMID: 32532611 DOI: 10.1016/j.clml.2020.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/26/2020] [Accepted: 05/03/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION We examined patient characteristics, treatments, and outcomes of patients with transformed mycosis fungoides (tMF) from COMPLETE: a large, multicenter, prospective cohort study of peripheral T-cell lymphoma patients in the United States. METHODS Patients with tMF were enrolled in COMPLETE at the time of transformation. For this analysis, we identified patients with tMF with completed baseline, treatment, and follow-up records. Median survival was assessed using Kaplan-Meier methodology. RESULTS Of the 499 patients enrolled in COMPLETE, 17 had tMF. Median age was 61; 53% were male, 9 had elevated lactate dehydrogenase, and 9 had lymph node involvement. Approximately one-quarter of the patients were African American and 47% had CD30+ disease. Median time to transformation was 53 months. All patients received systemic therapy, with 19% receiving concomitant radiotherapy. Most patients (87%) received single agents, including liposomal doxorubicin, pralatrexate, and gemcitabine. Eight patients (50%) had reported responses to therapy. Median survival was 18 months. One- and 2-year survival rates were 56% and 44%, respectively. CONCLUSIONS tMF often expresses CD30 and presents with lymph node involvement. Responses have been seen with single agents, but survival remains poor. Novel treatment approaches are urgently needed to improve outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Barbara Pro
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
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