First-line combination of GELOX followed by radiation therapy for patients with stage IE/IIE ENKTL: An updated analysis with long-term follow-up

Abstract

Abstract. In recent years, asparaginase-based chemotherapy regimens have produced excellent short-term efficacy in patients with extranodal natural killer/T-cell lymphoma (ENKTL). However, few long-term outcomes have been reported to date. A phase II clinical trial evaluating the efficacy and safety of a combination of gemcitabine, oxaliplatin and asparaginase (GELOX), followed by radiotherapy (RT) in the treatment of localized ENKTL, was reported by this group in 2012. By the time of the present analysis, detailed information had been collected for all 27 patients in the phase II trial, over an extended follow-up period. The median follow-up time was 63.15 months. The 5-year overall survival and progression-free survival were 85.0 and 74.0%, respectively. Recurrence within the RT field was observed in three patients, and the planning target-volume control rate at 5 years was 88.9%. One patient with confirmed lung invasion who did not respond to autologus stem cell transplantation (ASCT) was successfully treated by salvage therapy with lenalidomide monotherapy, and the EBV DNA load in this individual reflected disease progression and treatment response. No clinically significant late toxicities were identified during follow-up visits. In conclusion, this updated analysis confirmed the long-term benefit of the GELOX regimen followed by RT, and demonstrated a good safety profile for this treatment. This strategy may be one of the most suitable options for the treatment of early stage ENKTL.

Diagnosis and management of extranodal NK/T cell lymphoma nasal type

“…With a median follow up of 63.2 months, local and systemic relapses occurred in 11.1% and 25.9%. 59 The 5-year OS and PFS were 85% and 74 %.…”

NCCN Guidelines Insights: T-Cell Lymphomas, Version 2.2018

“…13 Sandwich chemoradiation (2 cycles of chemotherapy followed by involved-field RT [56 Gy] followed by 2-4 cycles of chemotherapy within 7 days of completion of involved-field RT) with asparaginase-or pegaspargase-based chemotherapy has been shown to be effective for the treatment of patients with newly diagnosed stage I-II ENKL-NT. [38][39][40] In a phase II study of 27 patients, sandwich chemoradiation with GELOX (L-asparaginase/gemcitabine/oxaliplatin) resulted in an ORR of 96% (CR, 74%). After a median follow-up of 63 months, 5-year OS and PFS rates were 85% and 74%, respectively.…”

“…Grade 3 or 4 toxicities were infrequent, and no treatmentrelated deaths were reported. 38 Sandwich chemoradiation with P-GEMOX is also effective for the treatment of patients with newly diagnosed ENKL (n=38), resulting in an ORR of 92% (CR, 87%). At a median follow-up of 15.5 months, the 1-year PFS and OS rates were both 87%.…”

Extranodal NK/T‐cell lymphoma, nasal type: Clinical features, outcome, and prognostic factors in 101 cases

“…10,33,34 The major improvement in ENKTL treatment was made when L-asparaginase was introduced into clinical use. Prospective study of sandwiched chemoradiotherapy with LVP (L-asparaginase, vincristine, and prednisone) 12,13 and GELOX (gemcitabine, oxaliplatin, and L-asparaginase) 14,35 regimen were conducted in China. Concurrent chemoradiotherapy with cisplatin followed by two courses VIDL (etoposide, ifosfamide, dexamethasone, L-asparaginase) was reported from Korea.…”