Outcomes for many cancers that were once considered untreatable have improved over the years as more treatment options become available. But for patients with peripheral T-cell lymphoma (PTCL), an aggressive form of blood cancer, outlook is bleak as relapses are common and choices of therapies remain limited.
The results of a multi-centre phase II study led by Singapore General Hospital (SGH) have shown that over 40 per cent of PTCL patients responded to a new drug combination of panobinostat and bortezomib, and half of them no longer had signs of cancer. These are relapsed patients or those who do not respond to conventional treatment.
“We decided to combine panobinostat and bortezomib to treat this group of patients as studies have suggested that both drugs work very well together. The novel treatment could also serve as a bridge for patients to receive curative stem-cell transplant, which was not an option for them previously,” said Associate Professor Goh Yeow Tee, Senior Consultant, Department of Haematology, SGH and senior author of the study.
The team, comprising of haematologists from five tertiary hospitals across Singapore, Malaysia and South Korea, recruited 25 patients for the study between 2009 and 2013 to determine the efficacy of the treatment regimen. Most patients had stage III or IV disease and no longer responded to current standards of care.
It was also observed that patients had a prolonged survival of 10 months on average and progression of disease was delayed by about three months. These gave sufficient time for five patients to undergo stem-cell transplant.
Each year, close to 700 people in Singapore are diagnosed with lymphomas. Twenty-five per cent are PTCL and only 10 per cent of them live beyond five years. Even with the use of strong chemotherapy or stem cell transplantation, the survival rate at 3 years is less than 30 per cent after diagnosis. This number is much higher than Western population. Lymphomas can occur at any age, but are most common in people in their 60s or older.
“With the success of this study, we hope that our locally developed treatment may eventually be recognised as a standard treatment for patients with peripheral T-cell lymphoma worldwide. This could potentially improve outcomes for this group of patients,” said Dr Daryl Tan, lead author of the study and Visiting Consultant, Department of Haematology, SGH. Dr Tan also practices at Raffles Cancer Centre.
Panobinostat is an oral drug approved by the United States Food and Drug Administration for treatment of multiple myeloma, another blood cancer, in Feb this year. Similarly, bortezomib, which is given intravenously, is also commercially available for multiple myeloma and another type of lymphoma.
The results were first released as an oral presentation at the American Society of Haematology Annual Congress in San Francisco in December 2014 and published online by the prestigious Lancet Haematology Journal on 8 July this year.