Category: Patient Education

ASCO 2014: Routine Surveillance has Limited Impact in Detecting Remission of Peripheral T-cell Lymphoma

By Tiffany Tang, MD

The role of routine surveillance imaging (RSI) in first complete remission (CR1) for peripheral T-cell lymphoma (PTCL) patients is unclear. Theoretically, RSI should allow for the earlier detection of asymptomatic relapses, thus leading to the earlier initiation of second line therapy. In an abstract presented during a session of the 2014 ASCO conference, we investigated the proportion of PTCL relapses detected by RSI and those found through clinical finding, before comparing the outcomes in patients from those two groups.

341 patients were retrospectively identified through the T-cell lymphoma databases of the National Cancer Centre Singapore/Singapore General Hospital and Weill-Cornell Medical College. These patients were divided into groups based on their mode of relapse detection; through RSI or clinical findings. PTCL subtypes included PTCL-NOS, AITL, ALCL (ALK positive and negative), EATL, GDT, HSTL and ATLL, while patients with leukemias, indolent, composite and cutaneous lymphomas were excluded. Of the 341 patients, 145 patients achieved CR1 and 64 relapsed. Relapses were detected by clinical findings in 51 patients, RSI in 9 patients and only 3 patients did not have any clinical findings at the time of relapse.

This data from our findings suggests that RSI does not often impact the detection of CR1 in patients with PTCL.

ASCO 2014: Romidepsin Plus Lenalidomide is Well Tolerated for Patients with Relapsed Lymphoma and Myeloma

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By Jia Ruan, MD, PhD

At a poster session of the 2014 ASCO meeting, results of a phase I trial were presented from an ongoing, multi-center, phase I/II study testing the combination of romidepsin and lenalidomide in patients with relapsed lymphoma and myeloma. Although romidepsin and lenalidomide have both been individually approved by the FDA for the treatment of lymphoma and multiple myeloma, the combination represents a novel experimental development, based on potentially synergistic mechanism of action, and non-overlapping toxicity of the two biologic agents.

The phase I portion of the trial evaluated toxicity, maximum tolerated dose, and clinical activity of the romidepsin and lenalidomide combination. Romidepsin was given intravenously on days 1, 8, and 15 and lenalidomide was given orally on days 1-21 of a 28-day cycle. From the 13 evaluable patient responses, there was an overall response rate of 54%, complete response rate of 15%, and partial response of 39%.

From these early results the investigators concluded that the combination of romidepsin and lenalidomide is well tolerated and lacks any unexpected toxicity. Responses were consistent across multiple lymphoma subtypes, and the upcoming disease specific phase II cohorts will include B-cell lymphomas, T-cell lymphomas, and multiple myeloma.

Reference

Lunning, MA. Ruan, J. Nair, S. (2014). A phase I/II trial of the combination of romidepsin and lenalidomide in patients with relapsed/refractory lymphoma and myeloma: Phase I results. [Abstract]. J Clin Oncol, 32:5s, (suppl. abstract 8582)

ASCO 2014: Promising Results with Lenalidomide Plus Rituximab for Patients with Previously Untreated Follicular Lymphoma

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By Peter Martin, MD

On May 30, 2014, at the 50th annual meeting of the American Society of Clinical Oncology (ASCO) I had the pleasure of presenting updated, preliminary results from the multi-center, national cooperative group CALGB 50803 phase II trial of lenalidomide plus rituximab in patients with previously untreated follicular lymphoma. This trial represents an important step as we move away from traditional cytotoxic chemotherapy towards a future with novel, better-tolerated regimens for treatment of patients with follicular lymphoma.

Patients in this trial received oral lenalidomide on days 1-21 of each 28-day cycle for a total of twelve cycles plus four weekly infusions of rituximab during cycle 1 followed by four additional infusions at the start of cycles 4, 6, 8, and 10. The primary objective was to measure the patient’s complete response rate. Overall, we found that the regimen was well tolerated, with very low rates of infection or other significant adverse events. Preliminary data from patients evaluable for complete response suggests that over 90% of patients responded, including roughly 70% complete responses. At two years, 89% of patients continued to respond. These efficacy data are consistent with what is typically seen with cytotoxic chemotherapy-based regimens and they support further evaluation of lenalidomide plus rituximab compared to chemotherapy in an ongoing phase III trial.