New Regimens Improve Survival in Patients With T-Cell Cancers

New regimens show the highest survival rates to date for two types of T-cell malignancies, according to a study presented at the American Society of Clinical Oncology (ASCO) Annual Meeting (June 1-5, 2018; Chicago, IL).

In a federally funded, randomized phase III trial performed by the Children’s Oncology Group, researchers examined survival rates associated with treatment regimens for patients with T-cell acute lymphoblastic leukemia (T-ALL) or T-cell lymphoblastic lymphoma (T-LL).

A total of 1895 patients were enrolled in the study. All patients received the standard, complex multi-drug chemotherapy regimen known as COG augmented Berlin-Frankfurt-Muster (aBFM) chemotherapy. In addition to receive aBFM, patients were randomly assigned to also receive either high-dose methotrexate in a hospital or escalating-dose methotrexate in an outpatient setting. 

Researchers noted that patients with moderate- to high-risk of cancer recurrence were also randomly assigned to receive nelarabine in addition to chemotherapy and cranial radiation. 

Researchers reported that a total of 90.2% of patients treated in this trial lived at least 4 years, with 84.3% showing no signs of cancer at 4 years. In the group of patients with T-ALL who had increased risk of recurrence, 88.9% of those who received nelarabine were leukemia-free at 4 years compared with 83.3% of patients not treated with nelarabine. Although patients with T-LL did not benefit from nelarabine, more than 85% lived for 4 years without disease. 

Additionally, had superior outcomes than those who received high-dose methotrexate. Among patients with T-ALL who were randomly assigned to receive both nelarabine and escalating doses of methotrexate, 92.2% were leukemia-free at 4 years. 

Researchers acknowledged that patients who did not have cancer remission following the initial phase of chemotherapy were assigned to receive high-dose methotrexate and nelarabine. A total of 54.8% of these patients survived 4 years without signs of the disease, a significant improvement as historically only 20% of patients with T-ALL who did not experience cancer remission lived another 3 years. 

“This is the largest trial ever conducted for newly diagnosed T-ALL and T-LL, and showed outstanding overall outcomes,” authors concluded. “Nelarabine improves disease-free survival for children and young adults with T-ALL and should become a new standard of care for this population.”—Janelle Bradley