Comparison of gemcitabine, oxaliplatin and L-asparaginase and etoposide, vincristine, doxorubicin, cyclophosphamide and prednisone as first-line chemotherapy in patients with stage IE to IIE extranodal natural killer/T-cell lymphoma: a multicenter retrospective study

Abstract

Optimal chemotherapy regimen for Extranodal natural killer/T-cell lymphoma (ENKTL) has not yet been defined. We retrospectively compared the outcome of 93 patients newly diagnosed with stage IE to IIE ENKTL who received gemcitabine, oxaliplatin and L-asparaginase (GELOX) (n = 40) or etoposide, vincristine, doxorubicin, cyclophosphamide and prednisone (EPOCH) (n = 53) as induction chemotherapy. After induction chemotherapy, the complete response (CR) rate and overall response rate (ORR) for the GELOX group were higher than those for the EPOCH group (70.0% vs. 41.5%, p = 0.007 for CR; 87.5% vs. 67.9%, p = 0.047 for ORR). The GELOX regimen resulted in significantly superior 5-year progression-free survival (PFS) (79.0% vs. 46.5%, p = 0.005) and overall survival (OS) rates (78.9% vs. 50.4%, p = 0.003). Toxicity of both regimens was acceptable. The GELOX regimen produces a better long outcome with less toxicity than the EPOCH regimen for patients with early stage ENKTL.

NCCN Guidelines Insights: T-Cell Lymphomas, Version 2.2018

“…Treatment should be individualized based on patient's tolerance and comorbidities. Retrospective comparative studies have shown that asparaginase-and pegaspargasebased regimens are associated with superior efficacy compared with conventional anthracycline-based regimens for the treatment of stage I-II disease, 50,51 with pegaspargase-based regimens preferred.…”

High post-treatment serum levels of soluble programmed cell death ligand 1 predict early relapse and poor prognosis in extranodal NK/T cell lymphoma patients

“…In ENKTCL patients, anthracyclines-based chemotherapy, such as CHOP, result in poorer responses because of high MDR gene expression in tumor cells [21]. Our prospective study demonstrated that asparaginase-based chemotherapy (GELOX) improved the CR rate in early stage ENKTCL patients and resulted in longer PFS and OS [6]. However, 20%-30% of ENKTCL patients are resistant to asparaginase-based chemotherapy, and there are no known biomarkers for predicting response to asparaginase-based regimens.…”

“…Because of the high rate of locoregional and systemic recurrence with standard radiotherapy treatment alone, chemotherapy has been integrated into the management of ENKTCL [4]. There is increasing evidence that asparaginase-based chemo-radiotherapy regimens are superior to anthracycline-based regimens in the treatment of ENKTCL due to overexpression of the multidrug-resistant (MDR) gene in tumor cells [5, 6]. Asparaginase-based chemotherapy combined with radiotherapy, which significantly improves long term survival rates, has therefore become the standard treatment for ENKTCL.…”

“…Asparaginase-based chemotherapy combined with radiotherapy, which significantly improves long term survival rates, has therefore become the standard treatment for ENKTCL. Despite recent progresses, nearly 30% of patients with localized ENKTCL still develop local and systemic failures and die due to disease progression [6, 7]. Identification of patients with a high risk of relapse is therefore crucial in ENKTCL treatment.…”

High numbers of CD68+ tumor-associated macrophages correlate with poor prognosis in extranodal NK/T-cell lymphoma, nasal type

“…(2) Patients with advanced stage ENKTL received chemotherapy alone. The chemotherapy regimens were as follows: (1) EPOCH (etoposide, doxorubicin, vincristine, cyclophosphamide, prednisone); (2) GELOX (gemcitabine, oxaliplatin, L-asparaginase) [23]. Patients received at two to six cycles of initial chemotherapy.…”