The performances of anticancer therapies are improving as time goes by. But some cancer types still use chemotherapy as a standard of care (SOC) developed in 1970s to this date, regardless of the technological advancement in the anticancer area. One of them is Peripheral T-Cell Lymphoma (PTCL).

Typically, PTCL is one kind of non-Hodgkin lymphoma found in T lymphocytes. The condition is categorized as a malignant tumor and an aggressive lymphoma. The tumor frequently spreads in liver, spleen and skin, and also has high risk of relapse and rapid advancement speed.

The problem is that the patients usually do not respond to the current SOC of a combined chemotherapy, and the prognosis of PTCL patients who fail in the first-line therapy or show relapse is not so positive with the median survival period lasting about 5.8 months.

Rare blood cancer area stuck with ‘70s chemotherapy showing low survival rate and frequently observed toxicity

#The current first-line SOC in PTCL treatment is a combination of chemotherapy including cyclophosphamide, doxorubicin hydrochloride (hydroxydaunorubicin), vincristine sulfate, and prednisone, or also known as CHOP, used from the ‘70s.

The CHOP chemotherapy has been used as a first-line treatment for decades, but the academic societies are torn about the therapy’s survival rate and toxicity. According to a clinical trial in Japan, PTCL patients’ three-year survival rate was only about 52 percent after receiving CHOP chemotherapy.

And high dosage of chemotherapy causing adverse reaction is considered as the biggest problem when treating the patients. Blood toxicity, such as leukopenia, anemia, thrombopenia could be caused by myelosupression, or the patients usually experience loss of hair, peripheral neuropathies, infection and nausea.

The reason why such high risk SOC is still used until today is because the disease has no other alternative options.

The treatment scene is not so different in South Korea. The National Cancer Information Center explains there are cases of the patients with PTCL or other non-Hodgkin lymphoma participating in clinical trials using new drugs, when they did not respond well enough to the SOC.

A professor of hematology and oncology at Samsung Medical Center, Kim Seok Jin explained, “Patients with PTCL are usually diagnosed in their 50s or 60s, and they are likely to get complications due to bone marrow suppression triggered by chemotherapy. Especially the patients in their 70s, some give up their treatment as they cannot endure the adverse reaction, and a lot of them see underwhelming treatment effect as they have to reduce the dosage considering the high risk of adverse reaction.”

”Desperately need to improve PTCL treatment access in South Korea” with the updated NCCN guideline

Although the PTCL treatment scene lacks varying treatment options with the said situations, a lymphoma treatment Adcetris (brentuximab) earned a new indication to treat PTCL and expanded the treatment option in December last year.

Adcetris is an antibody-drug conjugate (ADC) directed to CD30, expressed on the surface of several types of PTCL.

A Phase III ECHELON-2 study evaluated the drug’s clinical benefit, where patients with CD30-positive PTCL have improved the overall survival (OS), compared to the SOC CHOP chemotherapy, without discovering more issue with adverse by using brentuximab as a first-line treatment.

During the study, a patient group receiving brentuximab plus CHP (cyclophosphamide- doxorubicin-prednisone) combination lessened the risk of death by 34 percent and significantly enhanced the OS, in comparison to the patient group using CHOP.

Also the Adcetris combination therapy demonstrated an outstanding treatment efficacy proven with other indicators of anticancer treatment efficacy like progression-free survival (PFS), objective response rate (ORR) and complete remission (CR). The median PFS in the Adcetris combination therapy group reached 48.2 months, which almost doubled the median PFS in the CHOP patient group with 20.8 months. The statistics prove that the combination therapy has brought down the risk of disease progression by 29 percent.

Based on the reported clinical efficacy, the current National Comprehensive Cancer Network (NCCN) guideline recommends using Adcetris plus CHP combination therapy for a first-line treatment in patients with CD30-positive PTCL as a ‘preferred regimen.’

However, the PTCL treatment scene in South Korea has a long way to go. The drug expanded the indication late last year, but it still has not resolved the healthcare reimbursement required for more practical prescription.

The drug faces the first threshold of winning the healthcare reimbursement, the Cancer Deliberation Committee meeting schedule on Nov. 25. And regarding the drug Professor Kim commented, “Both the patients and healthcare providers are happy to have a new treatment option with superior efficacy than the existing SOC, as there were limited prescription options for patients with PTCL. There is definitely a big difference between not having an option at all and having option that cannot be accessed.”

The professor continued, “It is regrettable the patients are giving up on treatment, because of financial reasons, regardless of the new available option with lessened toxicity and good efficacy. I wish their access to treatment can be better as soon as possible for them to live longer. And granting the healthcare reimbursement on the drug would be cost-effective as there are only a handful of PTCL patients in South Korea.”