Fante Matthias A, Felsenstein Mona, Mayer Stephanie, Gerken Michael, Klinkhammer-Schalke Monika, Herr Wolfgang, Vogelhuber Martin, Reichle Albrecht, Heudobler Daniel
Department of Internal Medicine III, Hematology and Internal Oncology, University Hospital Regensburg, Regensburg, Germany.
Bavarian Cancer Registry, Regional Centre Regensburg, Bavarian Health and Food Safety Authority, Regensburg, Germany.
Front Oncol. 2022 May 10;12:852987. doi: 10.3389/fonc.2022.852987. eCollection 2022.
Treatment options in patients (pts.) with advanced relapsed and refractory aggressive B-cell lymphoma are limited. Palliative all-oral chemotherapy regimens reduce in-patient visits and contribute to quality of life. The all-oral low-dose chemotherapy regimen TEPIP comprises the conventional chemotherapy agents trofosfamide, etoposide, procarbazine, idarubicin and prednisolone.
Safety and efficacy of TEPIP was evaluated in an observational retrospective, single-center study at the University Medical Center Regensburg between 2010 and 2020. Treatment with TEPIP was applied for 7 or 10 days during a 28-days period. In a subgroup of fit and therapy-motivated pts. rituximab was added. End points were overall survival (OS) and progression free survival (PFS). Adverse events ≥ CTCAE grade III were reported.
35 highly pre-treated pts. with aggressive B-cell lymphoma were enrolled. Median age at TEPIP start was 67 years and 85% of pts. received TEPIP as ≥ third treatment line. Overall response rate (ORR) was 23% (CR 17%). Pts. benefited from additional rituximab administration (ORR 67%) and a lower number of pre-treatments (ORR 41%). The OS was 3.3 months (m) with a 1y-OS of 25.7% and the PFS amounted to 1.3 m with a 1y-PFS of 8.8%. OS and PFS were significantly prolonged in pts. that responded to treatment or additionally received rituximab. Adverse events were mainly hematological and occurred in 49% of pts.
TEPIP was well-tolerated and induced respectable response in a difficult-to-treat patient cohort. In particular, the all-oral administration enables out-patient use with palliative intent.
晚期复发难治性侵袭性B细胞淋巴瘤患者的治疗选择有限。姑息性全口服化疗方案可减少住院次数并有助于提高生活质量。全口服低剂量化疗方案TEPIP由传统化疗药物曲磷胺、依托泊苷、丙卡巴肼、伊达比星和泼尼松龙组成。
2010年至2020年期间，在雷根斯堡大学医学中心进行了一项观察性回顾性单中心研究，评估TEPIP的安全性和有效性。在28天周期内，TEPIP治疗7天或10天。在一组身体状况良好且有治疗意愿的患者亚组中加入了利妥昔单抗。终点指标为总生存期（OS）和无进展生存期（PFS）。报告了≥3级的不良事件（依据美国国立癌症研究所常见不良反应事件评价标准）。
纳入了35例接受过高度预处理的侵袭性B细胞淋巴瘤患者。开始使用TEPIP时的中位年龄为67岁，85%的患者接受TEPIP作为≥三线治疗。总缓解率（ORR）为23%（完全缓解率为17%）。患者从额外使用利妥昔单抗（ORR为67%）和较少的预处理次数（ORR为41%）中获益。OS为3.3个月，1年总生存率为25.7%，PFS为1.3个月，1年无进展生存率为8.8%。对治疗有反应或额外接受利妥昔单抗治疗的患者的OS和PFS显著延长。不良事件主要为血液学事件，49%的患者发生此类事件。
TEPIP耐受性良好，在难治性患者队列中诱导出了可观的反应。特别是，全口服给药使其可用于门诊姑息治疗。
