Michelle A. Fanale, MD, associate professor, Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses challenges with treatment options for patients with T-cell lymphoma.

The selection of treatments for patients with T-cell lymphoma is a main challenge that is facing this field, states Fanale. When comparing the new agents, they seem to have an overall response rate of 30% to 40% and have complete remission rates between 15% and 20%.

Many of the ongoing clinical trials in this space are attempting to determine which treatment is more suitable for an individual patient through molecular profiling, explains Fanale.

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Dr. Fanale on Challenges Facing Treatments in T-Cell Lymphoma

Michelle A. Fanale, MD, Associate Professor, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses the potential of antibody-drug conjugates, as a new category of therapy for patients with cancer.

Brentuximab vedotin (Adcetris), the first FDA approved antibody-drug conjugate, is indicated to treat patients with Hodgkin lymphoma and systemic anaplastic large cell lymphoma following progression on prior therapies. In addition to relapsed patients, Fanale anticipates potential for brentuximab as a frontline treatment. She believes the frontline administration of brentuximab plus chemotherapy may have the potential to prevent relapse.

Fanale adds that brentuximab sets the stage for the development of similar drug conjugates. These novel agents could herald a new era in cancer development, similar to the advent of monoclonal antibody therapies.

Michelle A. Fanale, MD, from the MD Anderson Cancer Center, discusses the potential of antibody-drug conjugates, as a new category of therapy for patients with cancer. 

Dr. Fanale on the Potential of Antibody-Drug Conjugates

Michelle A. Fanale, MD, Associate Professor, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses the role of brentuximab vedotin as frontline treatment of systemic anaplastic large cell lymphoma (ALCL).

In the phase II trial, patients with low-risk factors saw a 70% to 80% chance of being in remission for five years, compared to 15% to 20% of patients with higher risk factors. In the phase III trial, Fanale says, researchers look to compare CHOP chemotherapy to brentuximab vedotin + CHP in the frontline treatment of mature T-cell lymphomas and to enroll patients with high-risk disease. The goal remains to improve outcomes for high-risk patients by escalating chemotherapy or adding a targeted therapy.

Brentuximab vedotin is currently approved for Hodgkin lymphoma in the third-line setting and ALCL in the second-line setting.

Michelle A. Fanale, MD, Associate Professor, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses the role of brentuximab vedotin as frontline treatment of systemic anaplastic large cell lymphoma.

Dr. Fanale on Brentuximab Vedotin in High-Risk ALCL

Michelle A. Fanale, MD, Associate Professor, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses a phase I trial that examined the frontline administration of brentuximab vedotin (Adcetris) for patients with subtypes of lymphoma. 

The trial enrolled 39 patients with high-risk systemic anaplastic large cell lymphoma (sALCL) and other CD30-positive mature T- and NK-cell lymphomas. The trial was divided into 3 arms. The first arm received 2 cycles of brentuximab (1.8 mg/kg) followed by 6 cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) at the standard dose. The remaining two arms received 6 cycles of brentuximab (1.8 mg/kg) in combination with standard-dose CHP (cyclophosphamide, doxorubicin, prednisone) for 6 cycles. Those who responded received subsequent single-agent brentuximab for up to 10 cycles.

Fanale believes that the most astounding finding from the trial is that all patients entered into remission. At the initial follow up of approximately 9 months, 26 patients had been analyzed from Arms 2 and 3. In all, 23 patients (88%) achieved a complete response and 100% experienced an objective response. Fanale notes that all non-sALCL patients experienced a complete response, specifically those with T-cell lymphomas. 

The toxicity profile was manageable in the trial with the occurrence of some peripheral neuropathy, Fanale notes. Furthermore she adds that brentuximab concurrently with CHP did not seem to make side effects worse when compared to sequential dosing with CHOP.

A phase III study is planned to compare CHOP to the combination of brentuximab and CHP in the frontline treatment of mature T-cell lymphomas.

Michelle A. Fanale, MD, from the MD Anderson Cancer Center, discusses a phase I trial that examined the frontline administration of brentuximab vedotin for patients with subtypes of lymphoma. 

Michelle A. Fanale, MD

Articles

Dr. Fanale on Challenges Facing Treatments in T-Cell Lymphoma

Dr. Fanale on the Potential of Antibody-Drug Conjugates

Dr. Fanale on Brentuximab Vedotin in High-Risk ALCL

Dr. Fanale on Frontline Brentuximab in Lymphoma