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

Abstract

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

• Authors: Yoshinobu Maeda, Hisakazu Nishimori, Isao Yoshida, Yasushi Hiramatsu, Masatoshi Uno, Yasufumi Masaki, Kazutaka Sunami, Taro Masunari, Yuichiro Nawa, Hiromichi Yamane, Hiroshi Gomyo, Tsutomu Takahashi, Tomofumi Yano, Keitaro Matsuo, Koichi Ohshima, Shigeo Nakamura, Tadashi Yoshino, Mitsune Tanimoto
• Journal: Haematologica (Haematologica) Vol. 102 Issue 12 Pg. 2097-2103 (12 2017) ISSN: 1592-8721 [Electronic] Italy
• PMID: 28971899 (Publication Type: Clinical Trial, Phase II, Journal Article, Multicenter Study)
• Copyright: Copyright© 2017 Ferrata Storti Foundation.

Chemical References

• Vincristine
• Etoposide
• Doxorubicin
• Cyclophosphamide
• Prednisone

Topics

• Adult
• Age Factors
• Aged
• Anemia (chemically induced)
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, adverse effects, therapeutic use, toxicity)
• Cyclophosphamide (administration & dosage, adverse effects, therapeutic use, toxicity)
• Doxorubicin (administration & dosage, adverse effects, therapeutic use, toxicity)
• Etoposide (administration & dosage, adverse effects, therapeutic use, toxicity)
• Febrile Neutropenia (chemically induced)
• Humans
• Lymphoma, T-Cell, Peripheral (complications, drug therapy)
• Middle Aged
• Neutropenia (chemically induced)
• Prednisone (administration & dosage, adverse effects, therapeutic use, toxicity)
• Thrombocytopenia (chemically induced)
• Treatment Outcome
• Vincristine (administration & dosage, adverse effects, therapeutic use, toxicity)