Phase II Trial of Concurrent Radiation and Weekly Cisplatin Followed by VIPD Chemotherapy in Newly Diagnosed, Stage IE to IIE, Nasal, Extranodal NK/T-Cell Lymphoma: Consortium for Improving Survival of Lymphoma Study

Kim, Seok Jin; Kım, Kihyun; Kim, Byung Soo; Kim, Chul Yong; Suh, Cheolwon; Huh, Jooryung; Lee, Sang Wook; Kim, Jin Seok; Cho, Jaeho; Lee, Gyeong Won; Kang, Ki Mun; Eom, Hyeon Seok; Pyo, Hong Ryull; Ahn, Yong Chan; Ko, Young Hyeh; Kim, Won Seog

doi:10.1200/jco.2009.23.8592

Cited by 304 publications

(288 citation statements)

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“…With a novel risk stratification and more accurate staging methods, including improved imaging techniques and molecular markers, [35][36][37] future research should aim to determine whether these patients at high risk of systemic failure can benefit from innovative, more effective systemic therapies, such as new chemotherapeutic regimens and molecular targeted therapies. [38][39][40][41] The incidence of CNS involvement was largely diverse, mainly depending on the pathological subtype and stage of NHL. 42,43 Similarly to another study, 44 we found a very infrequent CNS relapse (1%) in patients with early stage nasal NK/T-cell lymphoma, not justifying the use of CNS chemoprophylaxis.…”

Section: Discussionmentioning

confidence: 99%

Failure patterns and clinical implications in early stage nasal natural killer/T‐cell lymphoma treated with primary radiotherapy

Wang

et al. 2011

Cancer

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BACKGROUND: This study aimed to evaluate the failure patterns and clinical implications in patients with early stage nasal natural killer (NK)/T-cell lymphoma treated with primary radiotherapy. METHODS: Two-hundred fourteen patients were included. There were 182 cases of stage I and 32 cases of stage II disease. Patients received radiotherapy alone (n ¼ 96) or radiotherapy and chemotherapy (n ¼ 118). The median dose was 50 grays, and most patients received doxorubicin-based chemotherapy. RESULTS: The 5-year overall survival (OS) and progression-free survival rates for all patients were 72% and 65%, respectively. Sixty-three patients experienced treatment failure. The 5-year cumulative incidences of locoregional, systemic, and overall failures were 12.0%, 25.5%, and 32.9%, respectively. Stage and paranasal extension were significant predictors for systemic failure. The 5-year cumulative incidence of systemic failure was 22.6% for stage I disease versus 42.7% for stage II disease (P < .001), and 16.9% for limited disease versus 30.4% for paranasal extension (P < .001), respectively. Adding chemotherapy to extended involved-field radiotherapy did not significantly decrease the systemic failure rate nor improve survival. The cumulative incidence of systemic failure and OS rate at 5 years were 24.1% and 74.4% for combined modality therapy compared with 28.5% (P ¼ 0.758) and 69.8% (P ¼ 0.529) for radiotherapy alone. A very low incidence of cervical lymph node or central nervous system relapse was observed. CONCLUSIONS: Patients with early stage nasal NK/T-cell lymphoma have excellent locoregional control and favorable prognosis with radiotherapy, but patients with stage II disease or paranasal extension are at high risk of systemic failure, emphasizing the importance of integration of optimal radiotherapy with innovative systemic therapy.

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Section: Discussionmentioning

confidence: 99%

Failure patterns and clinical implications in early stage nasal natural killer/T‐cell lymphoma treated with primary radiotherapy

Wang

et al. 2011

Cancer

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“…However, detailed information about the inclusion criteria, RT planning, and rationale for estimated sample size was not reported, although the researchers stated that these two studies had been conducted prospectively [11].…”

Section: Prospective Clinical Trials For Newly Diagnosed Localized Namentioning

confidence: 99%

“…To explore a more effective therapy for localized nasal NKTCL, prospective clinical trials of concurrent chemoradiotherapy incorporating chemotherapies with non-MDR-related agents and etoposide, which is effective against EBV-associated hemophagocytic syndrome [35], have been initiated in Japan [10] and soon after in Korea [11]. Figure 1 illustrates the protocol treatment of the two trials.…”

Section: Prospective Clinical Trials For Newly Diagnosed Localized Namentioning

confidence: 99%

“…The analyses of toxicity confirmed that fulldose DeVIC is inappropriate due to acute and late toxicities with the concurrent use of RT in this trial. Subsequent to the JCOG0211 trial, a Korean group (Consortium for Improving Survival of Lymphoma; CISL) initiated a multicenter phase II study of concurrent chemoradiotherapy followed by VIPD (etoposide, ifosfamide, cisplatin, and dexamethasone) chemotherapy for untreated localized nasal NKTCL in 2006 [11]. In this trial, cisplatin was selected for concurrent chemoradiotherapy as a radiation sensitizer.…”

Section: Prospective Clinical Trials For Newly Diagnosed Localized Namentioning

confidence: 99%

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Current and future management of NK/T-cell lymphoma based on clinical trials

Yamaguchi

2012

Int J Hematol

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Recently reported results of well-designed prospective clinical trials for extranodal NK/T-cell lymphoma, nasal type (ENKL) have rapidly changed the management of ENKL. This review will focus on the evidence obtained from prospective clinical trials for ENKL and discuss the most highly recommended current management and future directions for the better management of ENKL. For patients with nasal NK/T-cell lymphoma of stage IE or contiguous stage IIE with cervical node involvement, concurrent chemoradiotherapy with radiotherapy (RT) and a two-thirds dose of DeVIC chemotherapy is recommended as a first-line treatment. To obtain the expected clinical outcome, performing RT following the same procedure as that reported is important. For the other patients with newly diagnosed ENKL, SMILE chemotherapy is recommended as an induction therapy. The Epstein-Barr virus DNA load in peripheral blood is useful for both prognostication and monitoring during the follow-up after treatment. Other L-asparaginasecontaining chemotherapies and chemotherapies containing non-multidrug resistance-related agents and etoposide are good options for elderly patients or patients with impaired organ function. As in the cases of other aggressive lymphomas, prospective clinical trials with adequate statistical considerations should be conducted to improve the prognosis of patients with ENKL.

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“…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%.…”

Section: Discussionmentioning

confidence: 99%

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

Liang

Gao

Chen

et al. 2016

Hematological Oncology

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The nasal type of extranodal natural killer/T‐cell lymphoma is a rare aggressive lymphoma with poor prognosis. To discover a successful treatment, we investigated the efficacy and safety of chemotherapy with methotrexate, etoposide, dexamethasone, and polyethylene glycol‐asparaginase (MESA). Three cycles of MESA were administered to 46 patients with new or relapsed/refractory natural killer/T‐cell lymphoma. Complete response after 3 treatment cycles was 43.5%, the overall response rate was 87%, and 2‐year overall survival was 83.4%. Complete response was significantly better for newly diagnosed patients than for patients with relapsed/refractory disease. Patients with newly diagnosed disease had a significantly better overall response rate after 1, but not after 2 or 3 treatment cycles. Overall survival and progression‐free survival did not differ over 2 years. Grade 1/2 toxicities were frequent, but MESA was associated with fewer grade 3/4 events or treatment‐related deaths. These results will require confirmation in larger prospective trials.

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Phase II Trial of Concurrent Radiation and Weekly Cisplatin Followed by VIPD Chemotherapy in Newly Diagnosed, Stage IE to IIE, Nasal, Extranodal NK/T-Cell Lymphoma: Consortium for Improving Survival of Lymphoma Study

Abstract: Patients with newly diagnosed, stages IE to IIE, nasal ENKTL are best treated with frontline CCRT.

Cited by 304 publications

References 25 publications

Failure patterns and clinical implications in early stage nasal natural killer/T‐cell lymphoma treated with primary radiotherapy

Failure patterns and clinical implications in early stage nasal natural killer/T‐cell lymphoma treated with primary radiotherapy

Current and future management of NK/T-cell lymphoma based on clinical trials

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

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