Future of T-Cell Lymphoma Treatment
The T-cell lymphomas, the peripheral T-cell lymphomas, as most people are aware, are pretty rare diseases. According to the latest WHO [World Health Organization] classification, there are now recognized about 30 distinct subtypes of the disease. Collectively, they comprise about 6,000 to 10,000 cases per year in the United States, comprising about 10% of all cases of non-Hodgkin's lymphoma.
The most common subtype of the disease is peripheral T-cell lymphoma, not otherwise specified -- kind of a default garbage term, where those entities that don't neatly fit into the other subtypes are sort of lumped there. There are only about 2,500 cases of that particular disease.
What most physicians and trainees know well is these diseases are distinctly different in their behavior from B-cell lymphomas, which are, by far, more common, accounting for about 85% of all lymphomas. While we recognize a relatively high cure rate -- maybe 60%, 70% -- with diffuse large B-cell lymphoma, the aggressive T-cell lymphomas, in contrast, have a cure rate that might only sit at around 20% or 25% when people use conventional chemotherapies, the standard of care we recognize as CHOP [cyclophosphamide, doxorubicin, vincristine, and prednisone] chemotherapy.
When you think about why patients with T-cell lymphoma do so poorly compared to their counterparts with B-cell disease, it's sort of enlightening to recognize the fact that the therapies we use in T-cell lymphomas historically are largely developed from the treatment of B-cell lymphoma and that we've never really successfully developed a discrete regimen just for patients with T-cell lymphoma. I think right now those tides are beginning to turn. In fact, since 2009, we have three new drugs that have been approved for the disease over the last decade.
While those drugs are not perfect, they actually represent interesting opportunities. They're drugs that appear to work only in T-cell lymphoma. They're not widely approved in other diseases, and now a lot of new data from our group and select others are beginning to demonstrate that combinations of these new drugs are able to produce response rates that are substantially greater than what we see with the single agents.
I believe the future of T-cell therapies is going to largely depend upon some of these novel combinations. There may be some merit in adding these new drugs to CHOP-based chemotherapy, but as a whole, I'm not as enthusiastic nor optimistic about those prospects.
Journal of Phlebology and Lymphology