Phase 2 trial of combined cisplatin, etoposide, gemcitabine, and methylprednisolone (PEGS) in peripheral T-cell non-Hodgkin lymphoma: Southwest Oncology Group Study S0350

Daruka Mahadevan, Joseph M. Unger, Catherine S Perry, Daniel O. Persky, Fay Young, Michael Leblanc, Richard I. Fisher, Thomas P Miller

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Abstract

Background: Patients with peripheral T-cell lymphomas (PTCLs) have inferior progression-free survival (PFS) and overall survival (OS) compared with patients who have aggressive B-cell non-Hodgkin lymphoma. Because PTCLs over express multidrug resistance gene 1/P-glycoprotein (MDR-1/P-gp), we devised platinum, etoposide, gemcitabine, and methylprednisolone (PEGS) with agents that are not substrates of the efflux pump. Gemcitabine was included because of its excellent single-agent activity in PTCL. Methods: Patients who had PTCL with stage II bulky disease, stage III or IV disease with extra-nodal, nodal, and transformed cutaneous presentations were eligible. Patients received intravenous cisplatin 25 mg/m2 on days 1 through 4, etoposide 40 mg/m 2 on days 1 through 4, gemcitabine 1000 mg/m2 on day 1, and methylprednisolone 250 mg on days 1 through 4 of a 21-day cycle for 6 cycles. Results: In total, 34 patients were enrolled, 33 were eligible, and 79% were newly diagnosed. Histologic types were PTCL not otherwise specified (n = 15), anaplastic lymphoma kinase (ALK)-negative anaplastic large cell lymphoma (n = 4), angioimmunoblastic T-cell lymphoma (n = 6), or other T-cell non-Hodgkin lymphomas (n = 8). Adverse events included 1 grade 5 infection with grade 3 or 4 neutropenia and 9 grade 4 hematologic toxicities. The overall response rate was 39% (47% in PTCL not otherwise specified, 33% in angioimmunoblastic T-cell lymphoma, 25% in ALK-negative and 38% in other T-cell non-Hodgkin lymphomas). The PFS rate at 2 years was 12% (95% confidence interval, 0.1%-31%), and the median PFS was 7 months. The OS rate at 2 years was 30% (95% confidence interval, 8%-54%), and the median OS was 17 months. Immunohistochemical analysis of P-gp expression revealed strong positivity in a subset of lymphoma cells (n = 6) and tumor endothelium (n = 25). Conclusions: Overall, PEGS was well tolerated, but OS was not considered promising given the design-specified targets. These Results may serve as a benchmark for future comparisons for non-CHOP regimens.

Original languageEnglish (US)
Pages (from-to)371-379
Number of pages9
JournalCancer
Volume119
Issue number2
DOIs
StatePublished - Jan 15 2013

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gemcitabine
Peripheral T-Cell Lymphoma
Methylprednisolone
Etoposide
Platinum
Non-Hodgkin's Lymphoma
Cisplatin
T-Cell Lymphoma
Disease-Free Survival
Survival
Survival Rate
Confidence Intervals
MDR Genes
Anaplastic Large-Cell Lymphoma
Benchmarking
B-Cell Lymphoma
Neutropenia
Endothelium
Lymphoma

Keywords

  • anaplastic lymphoma kinase-negative anaplastic large cell lymphoma
  • angioimmunoblastic T-cell lymphoma
  • chemotherapy
  • multidrug resistant proteins
  • not otherwise specified
  • peripheral T-cell lymphoma

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Phase 2 trial of combined cisplatin, etoposide, gemcitabine, and methylprednisolone (PEGS) in peripheral T-cell non-Hodgkin lymphoma : Southwest Oncology Group Study S0350. / Mahadevan, Daruka; Unger, Joseph M.; Perry, Catherine S; Persky, Daniel O.; Young, Fay; Leblanc, Michael; Fisher, Richard I.; Miller, Thomas P.

In: Cancer, Vol. 119, No. 2, 15.01.2013, p. 371-379.

Research output: Contribution to journalArticle

Mahadevan, Daruka ; Unger, Joseph M. ; Perry, Catherine S ; Persky, Daniel O. ; Young, Fay ; Leblanc, Michael ; Fisher, Richard I. ; Miller, Thomas P. / Phase 2 trial of combined cisplatin, etoposide, gemcitabine, and methylprednisolone (PEGS) in peripheral T-cell non-Hodgkin lymphoma : Southwest Oncology Group Study S0350. In: Cancer. 2013 ; Vol. 119, No. 2. pp. 371-379.
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title = "Phase 2 trial of combined cisplatin, etoposide, gemcitabine, and methylprednisolone (PEGS) in peripheral T-cell non-Hodgkin lymphoma: Southwest Oncology Group Study S0350",
abstract = "Background: Patients with peripheral T-cell lymphomas (PTCLs) have inferior progression-free survival (PFS) and overall survival (OS) compared with patients who have aggressive B-cell non-Hodgkin lymphoma. Because PTCLs over express multidrug resistance gene 1/P-glycoprotein (MDR-1/P-gp), we devised platinum, etoposide, gemcitabine, and methylprednisolone (PEGS) with agents that are not substrates of the efflux pump. Gemcitabine was included because of its excellent single-agent activity in PTCL. Methods: Patients who had PTCL with stage II bulky disease, stage III or IV disease with extra-nodal, nodal, and transformed cutaneous presentations were eligible. Patients received intravenous cisplatin 25 mg/m2 on days 1 through 4, etoposide 40 mg/m 2 on days 1 through 4, gemcitabine 1000 mg/m2 on day 1, and methylprednisolone 250 mg on days 1 through 4 of a 21-day cycle for 6 cycles. Results: In total, 34 patients were enrolled, 33 were eligible, and 79{\%} were newly diagnosed. Histologic types were PTCL not otherwise specified (n = 15), anaplastic lymphoma kinase (ALK)-negative anaplastic large cell lymphoma (n = 4), angioimmunoblastic T-cell lymphoma (n = 6), or other T-cell non-Hodgkin lymphomas (n = 8). Adverse events included 1 grade 5 infection with grade 3 or 4 neutropenia and 9 grade 4 hematologic toxicities. The overall response rate was 39{\%} (47{\%} in PTCL not otherwise specified, 33{\%} in angioimmunoblastic T-cell lymphoma, 25{\%} in ALK-negative and 38{\%} in other T-cell non-Hodgkin lymphomas). The PFS rate at 2 years was 12{\%} (95{\%} confidence interval, 0.1{\%}-31{\%}), and the median PFS was 7 months. The OS rate at 2 years was 30{\%} (95{\%} confidence interval, 8{\%}-54{\%}), and the median OS was 17 months. Immunohistochemical analysis of P-gp expression revealed strong positivity in a subset of lymphoma cells (n = 6) and tumor endothelium (n = 25). Conclusions: Overall, PEGS was well tolerated, but OS was not considered promising given the design-specified targets. These Results may serve as a benchmark for future comparisons for non-CHOP regimens.",
keywords = "anaplastic lymphoma kinase-negative anaplastic large cell lymphoma, angioimmunoblastic T-cell lymphoma, chemotherapy, multidrug resistant proteins, not otherwise specified, peripheral T-cell lymphoma",
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year = "2013",
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T1 - Phase 2 trial of combined cisplatin, etoposide, gemcitabine, and methylprednisolone (PEGS) in peripheral T-cell non-Hodgkin lymphoma

T2 - Southwest Oncology Group Study S0350

AU - Mahadevan, Daruka

AU - Unger, Joseph M.

AU - Perry, Catherine S

AU - Persky, Daniel O.

AU - Young, Fay

AU - Leblanc, Michael

AU - Fisher, Richard I.

AU - Miller, Thomas P

PY - 2013/1/15

Y1 - 2013/1/15

N2 - Background: Patients with peripheral T-cell lymphomas (PTCLs) have inferior progression-free survival (PFS) and overall survival (OS) compared with patients who have aggressive B-cell non-Hodgkin lymphoma. Because PTCLs over express multidrug resistance gene 1/P-glycoprotein (MDR-1/P-gp), we devised platinum, etoposide, gemcitabine, and methylprednisolone (PEGS) with agents that are not substrates of the efflux pump. Gemcitabine was included because of its excellent single-agent activity in PTCL. Methods: Patients who had PTCL with stage II bulky disease, stage III or IV disease with extra-nodal, nodal, and transformed cutaneous presentations were eligible. Patients received intravenous cisplatin 25 mg/m2 on days 1 through 4, etoposide 40 mg/m 2 on days 1 through 4, gemcitabine 1000 mg/m2 on day 1, and methylprednisolone 250 mg on days 1 through 4 of a 21-day cycle for 6 cycles. Results: In total, 34 patients were enrolled, 33 were eligible, and 79% were newly diagnosed. Histologic types were PTCL not otherwise specified (n = 15), anaplastic lymphoma kinase (ALK)-negative anaplastic large cell lymphoma (n = 4), angioimmunoblastic T-cell lymphoma (n = 6), or other T-cell non-Hodgkin lymphomas (n = 8). Adverse events included 1 grade 5 infection with grade 3 or 4 neutropenia and 9 grade 4 hematologic toxicities. The overall response rate was 39% (47% in PTCL not otherwise specified, 33% in angioimmunoblastic T-cell lymphoma, 25% in ALK-negative and 38% in other T-cell non-Hodgkin lymphomas). The PFS rate at 2 years was 12% (95% confidence interval, 0.1%-31%), and the median PFS was 7 months. The OS rate at 2 years was 30% (95% confidence interval, 8%-54%), and the median OS was 17 months. Immunohistochemical analysis of P-gp expression revealed strong positivity in a subset of lymphoma cells (n = 6) and tumor endothelium (n = 25). Conclusions: Overall, PEGS was well tolerated, but OS was not considered promising given the design-specified targets. These Results may serve as a benchmark for future comparisons for non-CHOP regimens.

AB - Background: Patients with peripheral T-cell lymphomas (PTCLs) have inferior progression-free survival (PFS) and overall survival (OS) compared with patients who have aggressive B-cell non-Hodgkin lymphoma. Because PTCLs over express multidrug resistance gene 1/P-glycoprotein (MDR-1/P-gp), we devised platinum, etoposide, gemcitabine, and methylprednisolone (PEGS) with agents that are not substrates of the efflux pump. Gemcitabine was included because of its excellent single-agent activity in PTCL. Methods: Patients who had PTCL with stage II bulky disease, stage III or IV disease with extra-nodal, nodal, and transformed cutaneous presentations were eligible. Patients received intravenous cisplatin 25 mg/m2 on days 1 through 4, etoposide 40 mg/m 2 on days 1 through 4, gemcitabine 1000 mg/m2 on day 1, and methylprednisolone 250 mg on days 1 through 4 of a 21-day cycle for 6 cycles. Results: In total, 34 patients were enrolled, 33 were eligible, and 79% were newly diagnosed. Histologic types were PTCL not otherwise specified (n = 15), anaplastic lymphoma kinase (ALK)-negative anaplastic large cell lymphoma (n = 4), angioimmunoblastic T-cell lymphoma (n = 6), or other T-cell non-Hodgkin lymphomas (n = 8). Adverse events included 1 grade 5 infection with grade 3 or 4 neutropenia and 9 grade 4 hematologic toxicities. The overall response rate was 39% (47% in PTCL not otherwise specified, 33% in angioimmunoblastic T-cell lymphoma, 25% in ALK-negative and 38% in other T-cell non-Hodgkin lymphomas). The PFS rate at 2 years was 12% (95% confidence interval, 0.1%-31%), and the median PFS was 7 months. The OS rate at 2 years was 30% (95% confidence interval, 8%-54%), and the median OS was 17 months. Immunohistochemical analysis of P-gp expression revealed strong positivity in a subset of lymphoma cells (n = 6) and tumor endothelium (n = 25). Conclusions: Overall, PEGS was well tolerated, but OS was not considered promising given the design-specified targets. These Results may serve as a benchmark for future comparisons for non-CHOP regimens.

KW - anaplastic lymphoma kinase-negative anaplastic large cell lymphoma

KW - angioimmunoblastic T-cell lymphoma

KW - chemotherapy

KW - multidrug resistant proteins

KW - not otherwise specified

KW - peripheral T-cell lymphoma

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DO - 10.1002/cncr.27733

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