First‐line combination of gemcitabine, oxaliplatin, and L‐asparaginase (GELOX) followed by involved‐field radiation therapy for patients with stage IE/IIE extranodal natural killer/T‐cell lymphoma

Abstract

BACKGROUND: Extranodal natural killer/T‐cell lymphoma, nasal type (ENKTL) is a distinct subtype of non‐Hodgkin lymphoma in which the upper aerodigestive tract is the most commonly involved site. To date, optimal treatment strategies and prognosis for patients with ENKTL have not been fully defined. METHODS: This prospective study was conducted to evaluate the efficacy and safety profiles of first‐line combined gemcitabine, oxaliplatin, and L‐asparaginase (GELOX) followed by involved‐field radiation therapy for patients with stage IE/IIE ENKTL. The primary endpoints were the complete response rate, the objective response rate, and toxicities. Secondary endpoints were overall survival and progression‐free survival. RESULTS: Twenty‐seven patients with newly diagnosed ENKTL were enrolled and completed the entire course of treatment. At the end of treatment, the overall response rate was 96.3%, including 20 patients (74.1%) who attained a complete response and 6 patients (22.2%) who attained a partial response. No patients developed disease progression during therapy. Grade 1 and 2 toxicities were frequent during GELOX, but grade 3 and 4 toxicities were few, and no treatment‐related deaths occurred. At a median follow‐up of 27.37 months, 7 patients (25.9%) experienced disease progression, and 4 of those patients died of disease. The rates of 2‐year overall and progression‐free survival were both 86%, and patients who attained a complete response at the end of treatment had significantly longer progression‐free survival (P = .012) and overall survival (P = .021) than patients who did not attain a complete response. CONCLUSIONS: The current results indicated that GELOX followed by involved‐field radiation therapy can be an effective and feasible treatment strategy for patients with stage IE/IIE ENKTL of the upper aerodigestive tract. These results will require further investigation in larger prospective trials. Cancer 2013. © 2012 American Cancer Society.

Retrospective Study of Pegaspargase, Gemicitabine, Oxaliplatin and Dexamethasone (Peg-GemOD) as a First-Line Therapy for Advanced-Stage Extranodal NK/T Cell Lymphoma

“…Moreover, pegaspargase displays lower incidence of antiasparaginase antibodies and more prolonged asparaginase activity in comparison with native L-asparaginase [13]. Therefore, several studies have reported encouraging results of the combination of gemcitabine, pegaspargase and oxaliplatin-based regimen for patients with stage I/II or relapsed/refractory ENKTL, such as GELOX (gemcitabine, pegaspargase and oxalipaltin) [2] and DDGP (gemcitabine, pegaspargase, cisplatin and dexamethasone) [6]. However, there are few studies available describing the efficacy of gemcitabine, pegaspargase and oxalipaltin combinations in newly diagnosed patients with stage III/ IV ENKTL.…”

“…In China, ENKTL makes up 5-10 % of all malignant lymphomas. Although patients with stage I/II ENKTL can achieve favorable long-term outcome from concurrent or sequential chemoradiotherapy [2,3], advanced-stage (stage III/IV) ENKTL is still highly invasive, respond unsatisfactorily to conventional combination chemotherapy with extremely low 1-year overall survival (OS) rate. Great efforts have been made to explore optimal systemic chemotherapy for advanced-stage ENKTL.…”

New Therapies in T-cell Lymphoma

“…67 Similar impressive phase II data was displayed using gemcitabine, l-asparaginase, and oxaliplatin (GELOX) followed by involved-field radiotherapy (56 Gy) for patients with stage IE/IIE Extranodal NK/T-cell lymphoma. 68 The overall response rate was 96% and complete response rate was 74%, and two-year OS and progressive free survival were both 86% in the 27 patients treated. None of these data are randomized but still seem likely to represent a step forward in the management of both localized and disseminated NK/T-cell lymphoma.…”

A phase 2 study of methotrexate, etoposide, dexamethasone, and pegaspargase chemotherapy for newly diagnosed, relapsed, or refractory extranodal natural killer/T‐cell lymphoma, nasal type: a multicenter trial in Northwest China

“…Three studies using simultaneous chemoradiotherapy42, 43, 44, 45 and 3 assessing chemotherapy followed by RT46, 47, 48 had ORRs of 78% to 96%, 2‐year OS rates of 78% to 88%, and 3‐year OS rates of 54% to 86%. The newly diagnosed patients in our study had an ORR of 88% and a 2‐year OS rate of 84%.…”