TCL-404: Use of Brentuximab-ICE and Romidepsin-ICE in Relapsed/Refractory Peripheral T-Cell Lymphoma

Context: Relapsed/refractory peripheral T-cell lymphoma (R/R PTCL) has a poor prognosis. Romidepsin (Ro) and brentuximab vedotin (Bv), a CD30 antibody-drug conjugate, has shown response rates ranging from 24–42% when used as monotherapy. Efficacy of these agents when combined with salvage chemotherapy such as ifosfamide, carboplatin, and etoposide (ICE) has been scarcely studied in PTCL. Objective: Report outcomes of Bv-ICE in CD30 (+) and Ro-ICE in CD30 (-) R/R PTCL. Design: We retrospectively identified R/R PTCL patients treated with Bv-ICE or Ro-ICE in Houston Methodist Cancer Center from 2016–2019. We used frequencies and median to analyze the quantitative variables. Setting: Institutional practice. Patients or other participants: All patients with R/R PTCL. Interventions: N/A. Main outcome measures: Response rates, transplant rates, and adverse event rates of Bv-ICE and Ro-ICE Results: There were 13 R/R PTCL patients, 6 treated with Bv-ICE and 7 with Ro-ICE. The median age was 65 years old. The male to female ratio was 5:5. More than 75% had stage IV PTCL. The most common subtype was PTCL, not otherwise specified (46.2%), followed by angioimmunoblastic T-cell lymphoma (30.8%). Bv-ICE had an overall response rate (ORR) of 66.7%, with all the patients achieving complete response (CR). The median duration of response (DOR) was 7.5 months. ORR was 71.4% for Ro-ICE; 57.1% of patients achieved CR. The median DOR was 6 months. Two patients treated with Bv-ICE and three treated with Ro-ICE received transplantation. Grade 3 and 4 cytopenias were seen more frequently with Ro-ICE (85.7%) than with Bv-ICE (66.7%). Abnormal renal and liver function tests were seen at a lower proportion (28.6% in Ro-ICE and 33.3% in Bv-ICE). Neuropathy was seen in a third of patients treated with brentuximab. At last, follow-up almost half of all treated patients were still alive. Conclusions: Treatment with Bv-ICE and Ro-ICE are effective salvage regimens for R/R PTCL. Both can improve remission rates prior to transplant with similar ORRs and CRs over 50%. More than a third of patients were able to receive transplantation. In our experience, a treatment strategy based on CD30 positivity is feasible and effective to treat patients with R/R PTCL.