EPOCH Is a Safe and Effective Treatment Option for Aggressive T-Cell Lymphomas

Sethi, Tarsheen; Gerstein, Rachael; Schiffer, Molly; Amin, Kejal; Agarwal, Sonal; Foss, Francine M.

doi:10.1182/blood-2021-151238

Cited by 3 publications

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The lower response rate seen in the intensive regimen is likely related to the underlying patient population as it seems patients with acute ATLL were more likely to be treated with more intensive regimens and those patients likely to have worse outcomes than others [25]. Studies with intensive regimens such as EPOCH [8], VCAP-AMP-VECP [26], and HyperCVAD [27] showed an ORR of 50–70% in the frontline setting [23].…”

Section: Discussionmentioning

confidence: 99%

“…The first group included patients treated with CHOP. The second group included patients who received “intensive chemotherapy” including HyperCVAD [7] and etoposide, doxorubicin, vincristine, cyclophosphamide, and prednisone (EPOCH) [8], VCAP-AMP-VECP) [9], and cyclophosphamide, doxorubicin, vincristine, etoposide and prednisone (CHOEP) [10]. The third group of patients “others” received interferon and zidovudine (AZT/IF) or gemcitabine (1,000 mg day 1, 8), oxaliplatin (100 mg day 1) (GemOx), pralatrexate as a single agent, or gemcitabine (1,000 mg on day 1, 8), cisplatin (25 mg on day 1, 8), and dexamethasone (40 mg on day 1, 8) (GDP).…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Poor Outcome of Adult T-Cell Leukemia/Lymphoma with Current Available Therapy: An Experience of Two Centers

Saeed,

Sandoval-Sus,

Castillo-Tokumori

et al. 2023

Oncol Res Treat

View full text Add to dashboard Cite

Introduction: Adult T-cell leukemia lymphoma (ATLL) is an aggressive mature T-cell neoplasm caused by human T-cell lymphotropic virus type 1 (HTLV-1) infection. Despite its poor prognosis, there is no standard therapy for ATLL due to its low incidence and the disease affecting only endemic geographical clusters. Methods: A retrospective evaluation of patients with the diagnosis of ATLL at Moffitt Cancer Center and Memorial Healthcare System was done to identify patients and disease characteristics along with the progression-free survival (PFS) and overall survival (OS) for the different therapies used. Results: The 61 patients analyzed showed a median age of 58 with 82.5% of them being of African American descent. The acute variant contributed to the majority of cases (43.9%), followed by 36.8% presenting as a lymphoma variant. There was no statistical difference in the PFS (6.4 m, 3.1 m, 2.1 m; p = 0.23) or OS (14 m, 8.9 m, 18.5 m; p = 0.14) between cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), intensive chemotherapy regimens, and other modalities, respectively. However, the patients who had complete or partial remission with first-line therapy had better OS (15.9 m vs. 7.2 m; p = 0.004). Conclusions: The study highlighted the poor outcome of the current regimens and the lack of a unifying protocol for this vicious disease. The acute variants were treated with more intensive regimens, but there was no difference in the OS between the three major options of CHOP, intensified chemotherapy, and others. This underscores the need for more clinical trials to develop better outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Poor Outcome of Adult T-Cell Leukemia/Lymphoma with Current Available Therapy: An Experience of Two Centers

Saeed,

Sandoval-Sus,

Castillo-Tokumori

et al. 2023

Oncol Res Treat

View full text Add to dashboard Cite

show abstract

“… 1 , 2 Dose adjusted (DA)-EPOCH (etoposide, prednisone, vincristine, doxorubicin, and cyclophosphamide) is an anthracycline-based regimen for PTCLs. 3 , 4 , 5 , 6 The programmed death (PD) pathway is an inhibitory immune checkpoint that downregulates T-cell activation and proliferation. PD-1 or PD-L1 expression on neoplastic T cells and stromal or innate immune cells is common in T-cell neoplasms.…”

mentioning

confidence: 99%

Frontline chemoimmunotherapy with nivolumab and dose-adjusted EPOCH in peripheral T-cell lymphoma: a phase 1 trial

Haverkos,

Zain,

Kamdar

et al. 2024

Blood Advances

View full text Add to dashboard Cite

show abstract

Front-line Chemo-immunotherapy with Nivolumab and Dose-Adjusted (DA) EPOCH in Peripheral T-cell Lymphoma: A Phase I Trial

Haverkos,

Zain,

Kamdar

et al. 2023

Preprint

View full text Add to dashboard Cite

Introduction:Dose-adjusted (DA)-EPOCH (etoposide, prednisone, vincristine, doxorubicin, and cyclophosphamide) is a frequently used first line chemotherapy regimen for peripheral T-cell lymphomas (PTCLs), but relapses are common and long-term outcomes are poor. Checkpoint blockade (CPB) immunotherapy has shown modest single agent efficacy in relapsed PTCLs. In other hematologic malignancies the combination of CPB and cytotoxic chemotherapy is promising. Methods: We conducted a Phase I trial to assess safety, spectrum of immune-related toxicity, and efficacy of nivolumab (Nivo) in combination with DA-EPOCH as front-line therapy for PTCLs. Patients received Nivo (360 mg) followed by DA-EPOCH every 21 days for six cycles. Patients were allowed to receive one cycle of standard-of-care chemotherapy prior to enrollment. Results:18 patients were enrolled: 7 PTCL-not otherwise specified (NOS), 6 nodal T-cell lymphomas with a T-follicular helper phenotype, 2 primary cutaneous gamma/delta T-cell lymphoma, 2 ALK negative anaplastic large cell lymphoma, and 1 subcutaneous panniculitis like T-cell lymphoma. Fifteen had an intermediate or high-risk International Prognostic Index. Immune related (ir) adverse events (AEs) of all grades occurred in 14 and 7 patients experienced ≥ grade 3 irAEs. Eight patients required discontinuation of Nivo due to irAEs. Of the 6 patients who received a cycle of anthracycline-based combination chemotherapy prior to enrollment, none experienced an irAE resulting in Nivo dose hold or discontinuation, compared to 8 of 12 patients whose first cycle was Nivo+DA-EPOCH. There were no hyperprogression events. Interim and end of therapy overall response rates were 94% and 89%, respectively (11 complete responses, 5 partial responses, and 2 progressive diseases). With a median follow up of 707 days, median progression free and overall survival is 434 and 714 days, respectively. Conclusions: Front-line Nivo + DA-EPOCH showed good feasibility and acceptable safety when Nivo was started after chemotherapy but was associated with frequent dose-limiting irAEs when administered synchronously. Efficacy was encouraging with lengthy responses in very high risk PTCL subtypes. Further investigation of front-line line CPB-chemotherapy combinations in PTCL is warranted using a sequential approach. The trial is registered with ClinicalTrials.gov, NCT 03586999.

show abstract

EPOCH Is a Safe and Effective Treatment Option for Aggressive T-Cell Lymphomas

Cited by 3 publications

References 0 publications

Poor Outcome of Adult T-Cell Leukemia/Lymphoma with Current Available Therapy: An Experience of Two Centers

Poor Outcome of Adult T-Cell Leukemia/Lymphoma with Current Available Therapy: An Experience of Two Centers

Frontline chemoimmunotherapy with nivolumab and dose-adjusted EPOCH in peripheral T-cell lymphoma: a phase 1 trial

Front-line Chemo-immunotherapy with Nivolumab and Dose-Adjusted (DA) EPOCH in Peripheral T-cell Lymphoma: A Phase I Trial

Contact Info

Product

Resources

About