Oncology Frontier: What are the new novel therapies for peripheral T-cell lymphoma?

　　《肿瘤瞭望》：PTCL的最新疗法有哪些？

　　Dr Federico: We now have a lot of new drugs that have been tested in the setting of relapsed or refractory disease. The results are promising but not enough to be able to say we have taken big steps forward in the treatment of this heterogeneous group of diseases. So my expectations are that we use the information we already have on the efficacy of several of these new compounds including the HDAC inhibitors， to use them as first-line therapy in combination with current compounds such as the combination of romidepsin with CHOP or with another class， pralatrexate plus CHOP or CHOEP. This is probably the route we should follow in including new agents in first-line therapy. I don’t know that there is room for a new class of treatments that is chemo-free using immune modulators， HDAC inhibitors or monoclonal antibodies， but what is certain is that CHOP alone is not enough. Several of these new agents are promising but their benefits are in terms of months (three to six months) with regard to prolonging progression-free survival. It is correct to use this data to be incorporated earlier in treatment but I would not be relying on those results in the second- or third-line. They are probably better than the classic compounds we have used so far， but not good enough. Once we demonstrate that romidepsin， pralatrexateand so on work， then we need to include them in first-line treatment.

　　Federico博士：目前有很多治疗复发或难治性PTCL的新药正在试验中。目前的研究结果令人鼓舞，但还不足以说这种异质性疾病治疗取得很大进步。所以，只能根据目前的研究结果，联合现有的有效药物（包括HDAC抑制剂），制定一线治疗的联合方案。比如罗米地辛（Romidepsin）联合CHOP方案或其它方案，普拉曲沙（ Pralatrexate）联合CHOP或CHOEP方案，把新药纳入T细胞淋巴瘤的一线治疗联合治疗方案中。我不知道完全省去化疗，而用免疫调节剂、HDAC抑制剂或单克隆抗体等新一代药物治疗T细胞淋巴瘤是否可行，但可以肯定的是单用CHOP方案治疗是不够的。这些新药有治疗效果，但是患者的PFS获益只有几个月（3~6个月）。但是作为二、三线治疗方案，这些新药的疗效比传统药物效果还要好些（虽然还是不如人意）。一旦罗米地辛、普拉曲沙这类药物的疗效得到证实，就可以纳入一线治疗方案。