Clinical feasibility of oral low-dose etoposide and sobuzoxane for conventional chemotherapy–intolerant lymphoma patients

ABSTRACT

Introduction: In Japan, etoposide or sobuzoxane, a type of topoisomerase II inhibitor, is orally administered in patients with lymphoma who cannot tolerate conventional combination chemotherapy. However, the related clinical data remain to be fully summarized.

Areas covered: We evaluate the efficacy and toxicity of etoposide and sobuzoxane.

Expert opinion: Previous studies on etoposide or sobuzoxane monotherapy, including those among patients who could not tolerate conventional chemotherapy, suggested a favorable overall response rate (ORR) with moderate gastrointestinal or liver/renal toxicity. As for adult T-cell leukemia/lymphoma, a clinical trial with a limited sample size exhibited an ORR of >70%. Remarkably, the percentage of patients with a poor performance status was high among those receiving etoposide/sobuzoxane. Given a lack of randomized studies, etoposide/sobuzoxane might be a therapeutic option for lymphoma in a palliative setting. In the future, prospective trials with a homologous treatment schedule are warranted, in which the association between clinical efficacy and characteristics of lymphomas, such as specific gene alterations, should be elucidated.

KEYWORDS:

• Etoposide
• sobuzoxane
• lymphoma
• ATL
• palliative therapies

Article highlights

• Etoposide or sobuzoxane is considered for patients with lymphoma who cannot tolerate conventional chemotherapy, especially in Japan.

• Owing to mild non-hematologic toxicity including gastrointestinal or liver/renal toxicity, etoposide/sobuzoxane would be a suitable option in a palliative setting.

• Compared with data from clinical trials of novel agents, data obtained from patients receiving etoposide/sobuzoxane showed a generally poor performance status (PS).

• Etoposide/sobuzoxane do not take priority over novel agents for the populations enrolled in clinical trials because of a small or non-strict trial design, no definite survival benefit over tumor reduction, and a lack of preclinical models.

• While a revised consensus report on ATL briefly described etoposide/sobuzoxane, these two agents are not mentioned in the latest NCCN guidelines for lymphoma.

Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

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

There is no consensus about HSCTs for PTCL patients. Thus, we

hope this review article will be a useful reference in daily practice.

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Funding

This paper received no funding.