Clinical studies have shown poor prognoses for patients with most subtypes of peripheral T-cell lymphoma (PTCL), especially for those who have received conventional chemotherapy, as well as high relapse and low overall survival rates, but doctors said a new antifolate could be an effective alternative to traditional treatments.
Chang Ming-chih (張明志), consultant hematologist and oncologist at Mackay Memorial Hospital, said an average of about 330 PTCL cases were reported in Taiwan each year in the past few years and the numbers appear to be growing, adding that there are many different types of PTCL and most of them are aggressive.
Chang said that a study conducted overseas in 2013 showed that the three-year survival rate of PTCL patients after their first relapse was only 18 percent, adding that survival rates can be increased significantly for those who receive hematopoietic stem cell transplantations (HSCT).
Photo: Ruby Chang
However, patients are sometimes too weak to undergo HSCT due to age or the side effects of conventional chemotherapy, or they are unwilling to accept treatment due the to high relapse rate, he said, adding that the average lifespan of PTCL patients after their first relapse or progression is about five-and-a-half months without HSCT.
Chang said that a new antifolate — Pralatrexate — has been proven to extend the duration of a response from therapy, which means it might give patients the chance to undergo HSCT and increase their survival rate.
Speaking in Taipei last weekend, Owen A. O’Connor, a professor of medicine and experimental therapeutics and the director of the Center for Lymphoid Malignancies at Columbia University Medical Center, said that the antifolate works by mimicking folic acids to selectively enter cells expressing RFC-1, a protein that is expressed in certain cancer cells but seldom in normal cells.
Once inside cancer cells, the Pralatrexate acts on the folate pathway, interfering with DNA synthesis and suppressing the growth of the cancer cell, he said.
A clinical study conducted on more than 100 adult patients with relapsed or refractory PTCL showed that the average response rate to the new drug was 29 percent and the average duration of response was 12 months, O’Connor said.
In most parts of the world, the typical frontline treatment for PTCL is a combination of chemotherapy commonly known as CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone), but only up to 20 percent of the patients that undergo CHOP are expected to be cured, he said.
The most common solution for treating patients who did not respond to CHOP is to give them more chemotherapy, but for patients with T-cell lymphoma, cancer cells become resistant to many types of chemotherapy, O’Conner said, adding: “So we need new drugs that work in a different mechanism from traditional chemotherapy.”
“It is important for doctors and patients alike to recognize that chemotherapy might not always be the answer, and to think about how to use new drugs as a bridge to curative therapy like transplantation or a strategy to manage the disease for long periods of time,” he said, adding that Pralatrexate has exhibited marked and durable activity in heavily treated patients across all subtypes of PTCL.
Chang said that lymphoma might develop in many parts of the body and there are many types and subtypes of the disease, so sometimes patients and physicians might have difficulty diagnosing it.
He advised people to see a doctor if they have the following symptoms: swelling in the whole body or in the neck or the armpits; painless lymph node enlargement; high fever for more than two weeks; night sweats; loss of 3 to 5 percent or more of body weight within six months; fatigue or nasal congestion (similar to sinusitis, but with bleeding).
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