Abstract
Asparaginase/pegaspargase containing regimens combined with radiotherapy are highly effective and considered the cornerstone of localized Natural killer/T-cell lymphoma (NKTL) treatment. However, these chemotherapy regimens inevitably cause relatively high incidence of treatment-related adverse events (TRAEs). Herein we retrospectively evaluated the efficacy and safety of the combined regimen of anti-PD-1 antibody, anlotinib and pegaspargase “sandwich” with radiotherapy in localized NKTL. Anti-PD-1 antibody and pegaspargase at 2500 U/m2 were administered on day 1, while anlotinib (12 mg once a day) was orally administered on days 1-14. The treatment was repeated every 3 weeks. All the eight patients included received 3 cycles of the regimen followed by radiotherapy and an additional 3 cycles. The overall response rate was 100%, and the complete response rate was 87.5%. With a median follow-up time of 35.5 months (range, 34.03-40.90 months), median PFS and OS times were not reached. The 3-year PFS and OS rates were 100% and 100%, respectively. All patients were alive at the last follow-up. No treatment-related death and no grade 4 TRAE was reported. No grade 3/4 hematological toxicity was detected, and half of the patients didn’t report any hematological toxicity. This study indicates that anti-PD-1 antibody combined with anlotinib and pegaspargase is a promising chemoradiotherapy regimen for localized NTKL, with mild toxicity and good tolerance.
Highlights
Natural killer/T-cell lymphoma (NKTL) is a rare and distinct subtype of non-Hodgkin’s lymphoma (NHL), which predominantly occurs in East Asia and Latin America [1, 2]
Overexpression of genes related to angiogenesis have been observed in NKTL [17]. Overexpression of both vascular endothelial growth factor A (VEGF-A) and its receptor VEGFR2 has been detected in NKTL tissues and cell lines at the mRNA and protein levels [17]. These findings provided a rationale to further explore the effect of antiangiogenic treatment in NKTL [17]
A total of 12 biopsy-proven and previously untreated NKTL cases diagnosed with stage I/II disease underwent combination therapy with anti-programmed death-1 (PD-1) antibody, anlotinib plus pegaspargase from September 2018 to May 2019 in our institution
Summary
Natural killer/T-cell lymphoma (NKTL) is a rare and distinct subtype of non-Hodgkin’s lymphoma (NHL), which predominantly occurs in East Asia and Latin America [1, 2]. Radiotherapy has been widely used in localized NKTL, and the combined. Anti-PD-1 Antibody in NK/T Cell Lymphoma strategy of radiotherapy systematic treatment has greatly improved the clinical outcome of these patients [3, 4]. Asparaginase and pegaspargase are key agents for NKTL treatment, and asparaginase/pegaspargase containing regimens (P-GEMOX, SMILE and DDGP) are highly effective in the combined treatment strategy [5–9]. These chemotherapy regimens consist of multiple toxic agents and inevitably have some hematological toxicity and risk of infection [5–9].
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