Optimizing chemotherapeutic strategies for peripheral T-cell lymphomas.
Peripheral T-cell lymphomas are a heterogenous mix of histology, as well as clinical presentation, and outcome and remain a challenging group of diseases to treat. Because of difficulty and variability in diagnosis, improvements in diagnostic technology, and changing classification systems over time, the interpretation of studies is complicated. In addition, the response to current treatments and long-term outcome is generally poor. This review outlines these problems and discusses the current status of treatment strategies, including the disappointing results with standard anthracycline-based therapy as well as experience with modifications to CHOP (cyclophosphamide/doxorubicin/vincristine/prednisone); increasing dose intensity; antimetabolites; and T-cell-targeted therapies. We conclude with a description of a new agent, pralatrexate, including the preclinical and early clinical experience as well as a description of a large phase II prospective trial. Because of the relative rarity of this group of diseases, large-scale prospective clinical trials are difficult to implement. New treatment strategies are needed if we hope to improve patient outcomes.
Rosenstein
Lori J
LJ
Department of Internal Medicine and Holden Comprehensive Cancer Center, University of Iowa College of Medicine, Iowa City, IA 52242, USA.
Link
Brian K
BK
D000630:Aminopterin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000031:analogs & derivatives / Q000627:therapeutic use; D004334:Drug Administration Schedule; D016503:Drug Delivery Systems; D006801:Humans; D016411:Lymphoma, T-Cell, Peripheral / Q000188:drug therapy*; D011241:Prednisone / Q000627:therapeutic use; D014750:Vincristine / Q000627:therapeutic use
C418863:10-propargyl-10-deazaaminopterin; D000964:Antimetabolites, Antineoplastic; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D000630:Aminopterin; D011241:Prednisone