Contemporary strategies to improve outcomes for peripheral T-cell lymphoma patients following the failure of first-line therapy

ABSTRACT

Introduction

T cell lymphomas are a heterogeneous group, with varying incidences, geographic patterns, and risk factors. Although until recently approached in a manner similar to B cell lymphomas, the treatment outcomes are poor and this disease is characterized by high relapse rates. The treatment advances in PTCL have been slow compared to B cell lymphomas. The outcomes of patients who progress following stem cell transplantation are worse.

Areas covered

This review focuses on the novel targeted agents that are approved and/or are under investigation for patients with relapsed/refractory PTCL. We conducted an electronic literature search of the studies using PubMed, clincaltrials.gov, MEDLINE, using the key words ‘PTCL,’ ‘second line therapy,’ and ‘targeted agents.’ Studies published before January 2020 were included in the search criteria.

Expert opinion

Development of newer therapies such as HDAC inhibitors and kinases are promising new agents with activity in relapsed/refractory PTCL. Combination therapy using novel agents may be the future for treatment of PTCL. Therapies in the next few years may take a more personalized approach taking into consideration not just the histology, but also the epigenomic landscape.

KEYWORDS:

• T cell lymphoma
• relapsed T cell lymphoma
• novel therapies in T cell lymphoma
• PTCL
• relapsed/refractory T cell lymphoma
• second line therapy in PTCL

Article highlights box

• Prognosis of refractory/relapsed PTCL remains poor, despite aggressive chemo-immunotherapy

• Approval of novel agents such as HDAC inhibitors and CD30+ antibody drug conjugates have brought about a significant change in the management of PTCL

• Combination therapies using these novel agents have resulted in improved clinical response rates and are likely to be an integral part in the treatment of relapsed/refractory disease

• Better understanding of the genomic landscape has led to the use of hypomethylating agents in PTCL with promising results.

• Aurora kinases inhibitors, anti-KIR3DL2 antibodies, CCR4 antibodies are being evaluated and are likely to be incorporated into treatment algorithms for PTCL

Declaration of interest

J Armitage is a consultant for Oncology Analytics, Partner Therapeutics, Samus Therapeutics, and Ascentage and is on the Board of Directors for Tesaro Bio Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.