Can We Repurpose BV-CHP for Better Outcomes in Peripheral T-Cell Lymphoma?

Abstract

Peripheral T-cell lymphoma (PTCL) remains a formidable challenge with limited treatment options. While advancements in non-Hodgkin B-cell lymphomas have led to improved outcomes, PTCL patients continue to face a grim prognosis. This review explores the potential of augmenting the standard BV-CHP regimen with etoposide and brentuximab vedotin consolidation to bridge this therapeutic gap. We delve into the rationale for this approach, considering the limitations of current treatment options and the potential benefits of these additions.

Introduction

Peripheral T-cell lymphoma (PTCL) represents a heterogeneous group of aggressive lymphomas with a dismal prognosis. Despite advancements in other hematological malignancies, treatment options for PTCL remain limited. The standard frontline regimen, BV-CHP (Brentuximab vedotin, Cyclophosphamide, Doxorubicin, and Prednisone) has shown some efficacy, but complete remission rates and long-term survival remain unsatisfactory. This review explores the potential of enhancing the BV-CHP regimen through the addition of etoposide and subsequent consolidation with brentuximab vedotin to improve outcomes for PTCL patients.

The Need for Improved Therapies

The stark contrast between the progress made in treating non-Hodgkin B-cell lymphomas and the persistent challenges in PTCL highlights the urgent need for novel therapeutic strategies. While BV-CHP has shown some efficacy, it is evident that additional approaches are required to optimize treatment outcomes.

Etoposide: A Potential Game-Changer?

Etoposide, a topoisomerase II inhibitor, has demonstrated activity in various hematological malignancies. Its addition to the BV-CHP regimen could potentially enhance the efficacy of the treatment by targeting a different mechanism of action. By incorporating etoposide, we may achieve a broader spectrum of anti-tumor activity, potentially leading to improved response rates and prolonged remissions.

Brentuximab Vedotin Consolidation: A Strategic Approach

Consolidation therapy aims to solidify treatment gains and prevent relapse. Brentuximab vedotin, a CD30-directed antibody-drug conjugate, has shown efficacy in PTCL. Consolidating treatment with brentuximab vedotin after induction therapy could potentially enhance the durability of response and improve overall survival.

Addressing Challenges and Future Directions

While the addition of etoposide and brentuximab vedotin consolidation to the BV-CHP regimen holds promise, several challenges need to be addressed. These include potential increased toxicity, cost implications, and the need for well-designed clinical trials to evaluate the efficacy and safety of this approach.

Conclusion

The treatment landscape for PTCL remains challenging, emphasizing the need for innovative therapeutic strategies. The potential benefits of adding etoposide to the BV-CHP regimen and subsequent consolidation with brentuximab vedotin warrant further investigation. Rigorous clinical trials are essential to determine the optimal treatment approach and improve outcomes for patients with PTCL.

By addressing the limitations of current treatments and exploring novel therapeutic avenues, we can hope to make significant strides in improving the prognosis for patients with this devastating disease.

Reference

Julia E, Bachy E. Etoposide addition and brentuximab vedotin consolidation in first-line treatment of CD30-positive peripheral T-cell lymphoma: can we improve BV-CHP?. Lancet Haematol. Published online July 24, 2024. doi:10.1016/S2352-3026(24)00207-2