SOHO 2024 | Therapeutic approaches in the front-line for patients with PTCL

Currently, the frontline standard management for patients with peripheral T-cell lymphomas is still CHOP-based therapy. This results in, you know, a significant portion of patients being cured, depending on the studies, up to 40% or so other studies suggesting it’s only 20% or so, however. And because a certain proportion of patients can be cured with this approach, this remains the standard approach. Unfortunately, attempts to augment this approach by adding other medicines to it have not yet found that they benefit a larger population without incurring toxicities that makes it harder for patients to get treatment. And so, giving CHOP or CHOP-based therapy remains the standard approach. With that said, there are ways of augmenting CHOP-based therapy.

There are some studies adding etoposide to CHOP, so that regimen is called CHOEP, and that seems to increase the complete remission rate to CHOP, but does come with increased GI toxicities, hematologic toxicities and risks of febrile neutropenia. And so that is really considered for fit patients and in the analyses of who benefits from the addition of etoposide, that’s been predominantly patients who are under 60. The exception to all of this is in patients who have anaplastic large cell lymphoma, which is a different subtype of peripheral T-cell lymphoma, ALK positive or negative, either expressing or not expressing the ALK protein, and in these patients giving brentuximab with a modification of CHOP without vincristine, CHP, is the standard of care that was shown to have an overall survival benefit in a randomized study against CHOP called ECHELON-2.