Therapeutic and palliative benefit from single-agent irinotecan in multiply treated and highly refractory cases of lymphoma

Abstract

e19554 Background: Multiple reports corroborate a role for irinotecan in the treatment of lymphoma. This study describes the Memorial Sloan Kettering experience with single-agent irinotecan in the management of heavily pretreated and highly refractory cases of lymphoma. Methods: Adult patients with histologically diagnosed relapsed or refractory lymphoma treated with irinotecan between 1/2001 and 8/2008 were identified. Treatment responses were evaluated based on the Revised Response Criteria for Malignant Lymphoma. Adverse reactions were evaluated based on the NCI Common Terminology Criteria for Adverse Events. Results: 30 patients were identified, 27 (90%) of whom received irinotecan after 3 or more prior regimens. 4 patients had Hodgkin Lymphoma (HL) and 26 had Non-Hodgkin lymphoma (NHL): 17 DLBCL, 6 transformed follicular lymphoma, 1 mantle cell lymphoma, 1 T-cell lymphoma and 1 Burkitt's. 25 patients were evaluable for response. 5 achieved an objective response (overall response rate 20%); 2 achieved complete remission (CR) and 3 partial remissions (PR). 8 patients (32%) had stable disease and 12 (48%) progressed on treatment. The median duration of response was 2.8 months (2.6–3.2), the median progression-free survival was 1.3 months (0.36 to 7.67) and the median overall survival was 3.9 months (0.30–63.4). Of the total cohort, 11 (36.6%) attained a clinically demonstrable improvement in symptomatology; 3 had resolution of pain syndromes, 5 had a reduction in the size or quantity of palpable masses, 2 had diminished fluid retention and 1 had an overall improvement in functional status. Adverse events occurring in more than 20% of cases included diarrhea (80%), leukopenia (67%), fatigue (36.6%) and thrombocytopenia (26.7%). Less common reactions included fever, febrile neutropenia, neuropathy, nausea and vomiting. Conclusions: Irinotecan has utility even in multiply treated and highly refractory cases of lymphoma. It can mitigate symptoms resulting from bulky disease and shows potential as a palliative treatment option. Although ORR was only 20%, two CRs were achieved suggesting benefit in select patients. Strategies that limit adverse reactions may enhance the agent's effectiveness in refractory lymphoma. No significant financial relationships to disclose.