Successful full-dose DeVIC therapy in a patient with advanced-stage extranodal natural killer/T-cell lymphoma refractory to l-asparaginase
Extranodal NK/T-cell lymphoma, nasal type (ENKTL), is a rare histologic subtype of non-Hodgkin lymphoma (NHL) . Concurrent chemoradiotherapy has improved the prognosis of localized ENKTL; its 5-year overall survival rate is 70% , whereas the prognosis of advanced-stage ENKTL remains poor; the 5-year overall survival rate is 47% .
ENKTL cells express the drug transporter P-glycoprotein, which is encoded by the MDR1 gene. Because P-glycoprotein pumps out cytotoxic agents, conventional CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) therapy is ineffective for ENKTL . Novel chemotherapeutic regimens comprising agents not targeted by P-glycoprotein have been developed in the past 10 years. Among several agents, l-asparaginase is thought to be a key agent based on preclinical and clinical studies [3, 5].
Compliance with ethical standards
Conflict of Interest
JW, SM, YI, SH, ToS, SY, AMM, SF, WM, TaS, and SWK declare no conflicts of interests. DM has received personal fees from Takeda, Janssen, Eisai, Biomedis International, Celgene, Sanofi, Kyowa Hakko Kirin, Fujifilm, Mochida, Ono, Mundipharma, and Chugai; and research finding from GlaxoSmithKline, SERVIER, Abbvie, MSD, Kyowa Hakko Kirin, Ono, and Chugai, outside the submitted work. KI has received personal fees from Kyowa Hakko Kirin, Bristol-Myers, and Shionogi, outside the submitted work.
Research involving humans or animals
Written informed consent was obtained from the patient.
- 2.Yamaguchi M, Tobinai K, Oguchi M, Ishizuka N, Kobayashi Y, Isobe Y, Ishizawa K, Maseki N, Itoh K, Usui N, Wasada I, Kinoshita T, Ohshima K, Matsuno Y, Terauchi T, Nawano S, Ishikura S, Kagami Y, Hotta T, Oshimi K (2009) Phase I/II study of concurrent chemoradiotherapy for localized nasal natural killer/T-cell lymphoma: Japan Clinical Oncology Group Study JCOG0211. J Clin Oncol 27:5594–5600CrossRefPubMedGoogle Scholar
- 3.Yamaguchi M, Kwong YL, Kim WS, Maeda Y, Hashimoto C, Suh C, Izutsu K, Ishida F, Isobe Y, Sueoka E, Suzumiya J, Kodama T, Kimura H, Hyo R, Nakamura S, Oshimi K, Suzuki R (2011) Phase II study of SMILE chemotherapy for newly diagnosed stage IV, relapsed, or refractory extranodal natural killer (NK)/T-cell lymphoma, nasal type: the NK-Cell Tumor Study Group study. J Clin Oncol 29:4410–4416CrossRefPubMedGoogle Scholar
- 7.Lim SH, Hong JY, Lim ST, Hong H, Arnoud J, Zhao W, Yoon DH, Tang T, Cho J, Park S, Ko YH, Kim SJ, Suh C, Lin T, Kim WS (2017) Beyond first-line non-anthracycline-based chemotherapy for extranodal NK/T-cell lymphoma: clinical outcome and current perspectives on salvage therapy for patients after first relapse and progression of disease. Ann Oncol 28:2199–2205CrossRefPubMedGoogle Scholar
- 8.Kim SJ, Kim K, Kim BS, Kim CY, Suh C, Huh J, Lee SW, Kim JS, Cho J, Lee GW, Kang KM, Eom HS, Pyo HR, Ahn YC, Ko YH, Kim WS (2009) Phase II trial of concurrent radiation and weekly cisplatin followed by VIPD chemotherapy in newly diagnosed, stage IE to IIE, nasal, extranodal NK/T-cell lymphoma: Consortium for Improving Survival of Lymphoma study. J Clin Oncol 27:6027–6032CrossRefPubMedGoogle Scholar
- 9.Michot JM, Mazeron R, Danu A, Lazarovici J, Ghez D, Antosikova A, Willekens C, Chamseddine AN, Minard V, Dartigues P, Bosq J, Carde P, Koscielny S, De Botton S, Ferme C, Girinsky T, Ribrag V (2015) Concurrent etoposide, steroid, high-dose Ara-C and platinum chemotherapy with radiation therapy in localised extranodal natural killer (NK)/T-cell lymphoma, nasal type. Eur J Cancer 51:2386–2395CrossRefPubMedGoogle Scholar
- 10.Okamoto M, Maruyama F, Tsuzuki M, Nomura T, Miyazaki H, Wakita M, Kojima H, Sobue R, Matsui T, Ino T (1994) Salvage chemotherapy for relapsed/refractory aggressive non-Hodgkin’s lymphoma with a combination of dexamethasone, etoposide, ifosfamide and carboplatin. Rinsho Ketsueki 35:635–641PubMedGoogle Scholar