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3 treatment settings, 3 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.
Immunohistochemistry for CD30 and for ALK protein on the biopsy, with fluorescence in situ hybridisation to confirm the rearrangement where the stain is equivocal. The large pleomorphic cells, the frequent expression of epithelial membrane antigen and the loss of several T-cell markers mean that a tumour stained with a short panel can be reported as a carcinoma or a sarcoma; CD30 and ALK are what prevent that. Staging covers the sites this disease reaches outside the lymph nodes: skin, bone, soft tissue, lung and liver.
Histopathology means looking at cancer cells under a microscope, and immunohistochemistry stains them for specific proteins. Together they are still the foundation of every diagnosis.
FDG PET is the standard PET scan. A radioactive sugar shows which tissues are burning glucose fast, which most cancers do.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
Add these to your appointment list, or take the full question set for this cancer.
Brentuximab vedotin with cyclophosphamide, doxorubicin and prednisone, on the strength of ECHELON-2, which randomised 452 people with untreated CD30-positive peripheral T-cell lymphoma, three-quarters of them with systemic anaplastic large cell lymphoma: five-year progression-free survival 51.4 per cent against 43.0 and overall survival 70.1 against 61.0 with chemotherapy alone. Vincristine is left out because brentuximab vedotin is itself a tubulin-directed agent and giving both causes unacceptable nerve damage. Unlike the other nodal T-cell lymphomas, ALK-positive disease does well enough that consolidating a first remission with an autologous transplant is generally not offered. The regimens and the cycle detail are on the peripheral T-cell lymphoma page.
The ADC that made the modern field credible (2011), for Hodgkin lymphoma and CD30+ lymphomas.
Cyclophosphamide is an alkylating chemotherapy that damages DNA in dividing cells. It is part of CHOP for lymphoma, AC for breast cancer and VAC for childhood sarcomas, clears lymphocytes before CAR-T and prevents graft-versus-host disease after transplant; bladder bleeding, infertility and secondary leukaemia are its harms.
The red chemotherapy drug from a soil bacterium that is still the backbone of treatment for sarcoma, lymphoma and breast cancer, limited by cumulative heart damage.
Prednisone is the everyday steroid tablet in cancer care. It is the P in CHOP and MOPP for lymphoma, part of childhood leukaemia treatment, and taken with abiraterone in prostate cancer.
A+CHP improved progression-free and overall survival over CHOP in CD30-positive peripheral T-cell lymphoma; approved in November 2018.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutropenia · ECHELON-1, A+AVD arm | 91% | 82% |
| Febrile neutropenia · ECHELON-1, A+AVD arm | 19% | 19% |
| Peripheral sensory neuropathy · ECHELON-1, A+AVD arm | 65% | 10% |
| Vomiting · ECHELON-1, A+AVD arm | 33% | 3% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
Brentuximab vedotin is highly active in relapsed systemic anaplastic large cell lymphoma, with response rates well above those seen in other peripheral T-cell lymphomas, and it is the usual choice for anyone who has not already had it. ALK inhibitors developed for lung cancer, crizotinib in particular, produce responses here and are used especially in children and young adults. Allogeneic transplant is offered to fit patients who respond. The detail is on the peripheral T-cell lymphoma page.
The ADC that made the modern field credible (2011), for Hodgkin lymphoma and CD30+ lymphomas.
Allogeneic stem cell transplantation replaces a patient's blood system with a donor's after conditioning chemotherapy, so donor immune cells hunt down leukaemia left behind. It remains the only cure for adverse-risk acute myeloid leukaemia, high-risk acute lymphoblastic leukaemia and Richter transformation, at the price of graft-versus-host disease.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutropenia · ECHELON-1, A+AVD arm | 91% | 82% |
| Febrile neutropenia · ECHELON-1, A+AVD arm | 19% | 19% |
| Peripheral sensory neuropathy · ECHELON-1, A+AVD arm | 65% | 10% |
| Vomiting · ECHELON-1, A+AVD arm | 33% | 3% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.