Jasmine Zain, MD, recaps the current and upcoming treatments in T-cell lymphoma and highlights the key clinical trials playing a role in the rare disease.
T-Cell lymphoma treatments have come a long way from chemotherapy. As more disease targets are being discovered, treatments are becoming more precise, and a result, changing the therapy landscape.
At the 60th ASH Annual Meeting & Exposition in San Diego, California, Jasmine Zain, MD, director of T-cell lymphoma at City of Hope, spoke with Rare Disease Report® about the current and upcoming treatments in T-cell lymphoma and highlighted the key clinical trials playing a role in the rare disease.
[Editor’s note: Transcript is slightly modified for readability.]
Zain: “Traditionally, chemotherapy has been used because that's what we used to have for any kind of lymphoma, but we very quickly understood that that was not enough for T-cell lymphomas.
Just like other cancers, as we learn more about the targets that are sort of faulty or abnormal in these patients in their tumors, we are starting to figure out treatments that can be targeted against that.
One of the very important trials that's being presented is what's called the ECHELON-2 to trial. It is a large, international trial that was done to better understand the role of a targeted treatment called brentuximab vedotin that targets CD30. It is being done in CD30-expressing lymphomas, and it's a randomized trial where the patients will either receive the standard chemotherapy CHOP [cyclophosphamide, doxorubicin, vincristine, prednisone], [while] the other the treatment arm—or the experimental arm—receive CHOP with brentuximab vedotin except with the omission of vincristine because the toxicity profile wouldn't have allowed that.
Again, this is the next step from a previously known or published phase 1 study of CHP [cyclophosphamide, doxorubicin, prednisone] plus brentuximab vedotin. So far, [this data] looks positive and may impact the outcomes of treatment of this disease and may be practice changing for CD30 positive T-cell lymphomas.
In fact, the data is probably so compelling, the US Food and Drug Administration (FDA) approved brentuximab vedotin for upfront treatment of CD30-expressing lymphomas in combination with the CHP chemotherapy. That's already practice changing, and [it] gives you an idea how of impactful this abstract is.
In addition, there are a lot of other combinations that are being presented. [They may] not [be] as impactful, but certainly for patients who don't express CD30 positivity in their tumors, we still need something that's similar. We're waiting to see what those results show.
One example is alemtuzumab, which target CD52 in combination with CHOP. There's another trial being presented of lenalidomide in combination with the chemotherapy called CHOEP [yclophosphamide, doxorubicin, etoposide, vincristine and prednisone], so these are all important abstracts and papers that will be presented at this meeting.
There's a lot of data regarding targeted therapies for patients with relapsed disease, particularly the PI3 kinase targeting agents. There are several papers on that, and that seems to be a promising treatment.
There are also other novel agents that are being tried in this lymphoma within an attempt to really move the field forward and change the outcomes of these patients.
There's also a form of T-cell lymphoma called cutaneous T-cell lymphoma, which presents as skin rashes. It is treated with the help of both dermatologists and hematologists, and there's a lot of new data for patients with cutaneous T-cell lymphomas as well, [which is] another incurable disease.
[ASH 2018] an exciting meeting for us.”