Aaron Goodman, MD, hematologist/oncologist and assistant professor of medicine at the University of California, San Diego, discusses the need for molecular subtyping in T-cell lymphomas.

Investigators should keep T-cell lymphomas separate from other lymphomas in clinical trials, says Goodman. Ideally, there would be separate trials for patients with specific subtypes of T-cell lymphomas as well, adds Goodman.

As more information regarding the genetic makeup of T-cell lymphoma emerges, focused research efforts on more specific patient populations may inform which therapies are best suited for each patient, says Goodman.

For example, patients with angioimmunoblastic T-cell lymphoma appear to have better responses to hypomethylating agents and histone deacetylase inhibitors compared with other types of T-cell lymphoma, says Goodman.

The identification of molecular subtypes in acute myeloid leukemia led to the development of targeted therapies. Similarly, molecular subtyping in T-cell lymphoma may be important in moving the needle forward, concludes Goodman.

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Aaron Goodman, MD, discusses the need for molecular subtyping in T-cell lymphomas.

Dr. Goodman on the Need for Molecular Subtyping in T-Cell Lymphomas

Aaron Goodman, MD, hematologist/oncologist and assistant professor of medicine at the University of California, San Diego, discusses the importance of the phase III ECHELON-2 data in peripheral T-cell lymphoma (PTCL).

The ECHELON-2 trial was the first multicenter, randomized study that showed a progression-free survival and overall survival (OS) benefit with brentuximab vedotin (Adcetris) plus chemotherapy in patients with newly diagnosed, CD30-expressing PTCL. The population in the study was predominantly patients with anaplastic large cell lymphoma, but it also included some of the more difficult-to-treat PTCLs, including angioimmunoblastic T-cell lymphomas, says Goodman.

The results changed the standard of care for patients with CD30-expressing PTCLs, says Goodman. Now, brentuximab vedotin plus chemotherapy is listed in the guidelines as frontline therapy for patients with PTCL and should be universally adopted as such, concludes Goodman.

Dr. Goodman on the Importance of the ECHELON-2 Data in PTCL

Aaron Goodman, MD, hematologist/oncologist and assistant professor of medicine at the University of California, San Diego, discusses the role of PD-1 inhibitors in T-cell lymphomas.

Initially, there was a lot of enthusiasm surrounding the use of PD-1 inhibitors in patients with T-cell lymphomas, but response rates have ranged from 10% to 30%, explains Goodman. Unlike other cancers, a protein on the T-cell lymphoma tumor must be targeted in order to activate it, thus releasing a natural break on the tumor cells. Several reports have cited hyperprogression in T-cell lymphomas treated with pembrolizumab (Keytruda) and nivolumab (Opdivo), which indicates that caution needs to be used with these agents, says Goodman.

With other targets, the new drug mogamulizumab-kpkc (Poteligeo) has been approved for use in cutaneous T-cell lymphomas. Mogamulizumab-kpkc is a monoclonal antibody that targets CCR4, which is found on regulatory T cells and malignant T cells, specifically in mycosis fungoides or Sézary syndrome, according to Goodman. The agent, when used as a monotherapy, has reasonable activity that can be durable in this patient population, concludes Goodman.

Aaron Goodman, MD, discusses the role of PD-1 inhibitors in T-cell lymphomas.

Dr. Goodman on the Role of PD-1 Inhibitors in T-Cell Lymphomas

Aaron Goodman, MD, hematologist/oncologist and assistant professor of medicine at the University of California, San Diego, discusses the role of transplant in patients with T-cell lymphomas.

The role of autologous stem cell transplantation (ASCT) in patients with peripheral T-cell lymphoma (PTCL) who achieve complete remission1 (CR1) after CHOP or brentuximab vedotin (Adcetris) plus CHP is not well defined. In the phase III ECHELON-2 trial, patients who underwent transplant after achieving CR1 with brentuximab vedotin and CHP had a progression-free survival rate of approximately 70% to 80%. However, subset analyses are subject to biases. In the absence of randomized data, the discussion of whether to proceed with transplant should be had on an individualized basis, says Goodman.

Most phase II studies and retrospective studies show better outcomes with ASCT in CR1 compared with those who did not receive ASCT. However, the data may be biased because patients who can get a transplant are more fit and are going to do better, explains Goodman. Regarding anaplastic large-cell lymphomas that are ALK-positive, transplant is not recommended if patients achieve CR1, concludes Goodman.

Dr. Goodman on the Role of Transplant in T-Cell Lymphoma

Aaron Goodman, MD, hematologist/oncologist and assistant professor of medicine at the University of California, San Diego, discusses factors that have contributed to the lack of treatment development in peripheral T-cell lymphoma (PTCL).

PTCL is a rare type of non-Hodgkin lymphoma (NHL) and makes up approximately 10% to 20% of the overall NHL patient population, says Goodman.

PTCL is a heterogenous disease with multiple subtypes, explains Goodman. Moreover, each subtype appears to respond differently to the available treatment options.

Prior to CD30, no actionable targets had been identified in PTCL, says Goodman. Conversely, B-cell malignancies, for example, have multiple potential targets, such as CD20 and the PI3K pathways.

Aaron Goodman, MD, discusses factors that have contributed to the lack of treatment development in peripheral T-cell lymphoma. 



Aaron Goodman, MD

Articles

Dr. Goodman on the Need for Molecular Subtyping in T-Cell Lymphomas

Dr. Goodman on the Importance of the ECHELON-2 Data in PTCL

Dr. Goodman on the Role of PD-1 Inhibitors in T-Cell Lymphomas

Dr. Goodman on the Role of Transplant in T-Cell Lymphoma

Dr. Goodman on Contributing Factors to the Lack of Development in PTCL Treatment