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Adult T-cell leukaemia has had one randomised trial, in 1998. Most T-cell lymphoma treatment rests on single-arm studies, and the diseases concentrated outside Europe and North America have the least evidence of all.
The obstacles are structural rather than scientific: no commercial sponsor for diseases concentrated in middle-income countries, regulatory fragmentation across the regions where the diseases occur, and the fact that a trial in a disease with 500 cases a year in any one country can only work internationally. The precedent is the international coordination that made paediatric leukaemia trials possible, which took decades and worked.
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Brentuximab vedotin is a standard for CD30-positive cutaneous T-cell lymphoma requiring systemic therapy, including large cell transformation.
The regimen that made extranodal NK/T-cell lymphoma treatable. The usual explanation is that asparaginase is not a substrate of the P-glycoprotein pump this tumour expresses, which would explain why it works where anthracycline-based regimens do not; that mechanism is widely repeated but has been contradicted by at least one series.
The Japanese standard regimen for aggressive adult T-cell leukaemia/lymphoma rests on this trial. Three-year overall survival of 24 per cent with the better arm is the plainest statement of how much room remains, and is why allogeneic transplantation, mogamulizumab and antiviral approaches have all been pursued since.
Shares Phase II study of SMILE chemotherapy for newly diagnosed stage IV, relapsed, or refractory extranodal natural killer (NK)/T-cell lymphoma, nasal type: the NK-Cell Tumor Study Group study, Asparaginase (pegaspargase, calaspargase pegol, Erwinia asparaginase), Prednisone, Vincristine and the tag lymphoma-evidence.
Shares VCAP-AMP-VECP compared with biweekly CHOP for adult T-cell leukemia-lymphoma: Japan Clinical Oncology Group Study JCOG9801, JCOG9801, Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome), Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma) and the tag lymphoma-evidence.
Shares VCAP-AMP-VECP compared with biweekly CHOP for adult T-cell leukemia-lymphoma: Japan Clinical Oncology Group Study JCOG9801, JCOG9801, Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma), Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting and the tag lymphoma-evidence.
Shares Prednisone, Trials enrol too few, too slowly, Vincristine, Rare and paediatric cancers without markets and the tag lymphoma-evidence.
Shares Prednisone, Vincristine, Etoposide, Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting and the tag lymphoma-evidence.
Shares Prednisone, Vincristine, Etoposide, Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting and the tag lymphoma-evidence.
Shares Prednisone, Trials enrol too few, too slowly, Vincristine, Rare and paediatric cancers without markets and the tag lymphoma-evidence.
Shares Prednisone, Trials enrol too few, too slowly, Vincristine, Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting and the tag lymphoma-evidence.