Nhl_extranodal-nk-t-cell-lymphoma_0712_webpdf.indd

The selection, dosing, and administration of anticancer agents and the management of associated toxicities are complex. Drug dose modifications and schedule and initiation of supportive care interventions are often necessary because of expected toxicities and because of individual patient variability, prior treatment, and comorbidities. Thus, the optimal delivery of anticancer agents requires a healthcare delivery team experienced in the use of such agents and the management of associated toxicities in patients with cancer. The cancer treatment regimens below may include both FDA-approved and unapproved uses/regimens and are provided as references only to the latest treatment strategies. Clinicians must choose and verify treatment options based on the individual patient.
Radiotherapy alone may yield more benefits on survival in patients with Stage I1, 2 Concurrent Chemoradiation: All stages of Nasal and Extranasal
Radiotherapy, followed by DeVic Day 1: Carboplatin 200mg/m2 IV.
(carboplatin [Paraplatin],
Days 1–3: Etoposide 67mg/m2 IV + ifosfamide 1.0g/m2 IV (plus mesna) +
Radiotherapy + cisplatin
Prior to VIPD: Cisplatin 30mg/m2 IV weekly, followed by
(Platinol), followed by VIPD
Days 1–3: Etoposide 100mg/m2 IV + ifosfamide 1,200mg/m2 IV (plus mesna) +
Days 1–4: Dexamethasone 40mg IV or orally.
Repeat every 3 weeks for 3 cycles.
Combination Chemotherapy Regimen (L-asparaginase based): Nasal Stage IV, Extranasal Stages I-IV
SMILE (dexamethasone +
Day 1: MTX 2g/m2 IV.
methotrexate [MTX] + ifosfamide Days 2–4: Leucovorin 15mg IV or orally for 4 doses + ifosfamide 1,500mg/m2 IV
+ L-asparaginase [Kidrolase] +
(plus mesna) + dexamethasone 40mg IV or orally + etoposide 100mg/m2 IV.
Days 8, 10, 12, 14, 16, 18, and 20: L-asparaginase 6,000 units/m2 IV.
Repeat cycle every 4 weeks.
AspaMetdex (L-asparaginase +
Days 2, 4, 6, and 8: L-asparaginase 6,000 units/m2 IM.
Day 1: MTX 3g/m2 IV.
Days 1–4: Dexamethasone 40mg.
Sequential Chemoradiation (Nasal Stages I-II)
SMILE (dexamethasone + MTX + Day 1: MTX 2g/m2 IV.
ifosfamide + L-asparaginase +
Days 2–4: Leucovorin 15mg IV or orally for 4 doses + ifosfamide 1,500mg/m2 IV
(plus mesna) + dexamethasone 40mg IV or orally + etoposide 100mg/m2 IV.
radiotherapy1
Days 8, 10, 12, 14, 16, 18, and 20: L-asparaginase 6,000 units/m2 IV.
Repeat cycle every 4 weeks.
VIPD (etoposide + ifosfamide +
Days 1–3: Etoposide 100mg/m2 IV + ifosfamide 1,200mg/m2 IV (plus mesna) +
followed by radiotherapy1
Days 1–4: Dexamethasone 40mg IV or orally.
Repeat every 3 weeks for 3 cycles.
References
1. NCCN Clinical Practice Guidelines in Oncology™. Non-Hodgkin’s newly diagnosed, stage IE to IIE, nasal, extranodal NK/T-cell Lymphoma. v.3.2012. Available at: http://www.nccn.org/pro lymphoma: consortium for Improving Survival of Lymphoma fessionals/physician_gls/pdf/nhl.pdf. Accessed July 12, 2012.
study. J Clin Oncol. 2009;27:6027–6032.
2. Huang MJ, Jiang Y, Liu WP, et al. Early or up-front radiotherapy 5. Yamaguchi M, Kwong YL, Kim WS, et al. Phase II study of SMILE improved survival of localized extranodal NK/T-cell lymphoma, chemotherapy for newly diagnosed stage IV, relapsed, or re- nasal-type in the upper aerodigestive tract. Int J Radiat Oncol fractory extranodal natural killer (NK)/T-cell lymphoma, nasal Biol Phys. 2008;70:166–174.
type: the NK-Cell Tumor Study Group study. J Clin Oncol. 2011:29:4410–4416.
3. Yamaguchi M, Tobinai K, Oguchi M, et al. Phase I/II study of 6. Jaccard A, Gachard N, Coppo P, et al. A prospective phase II concurrent chemoradiotherapy for localized nasal natural killer/ trial of an L-asparaginase containing regimen in patients with T-cell lymphoma: Japan Clinical Oncology Study JCOG0211. refractory or relapsing extra nodal NK/T-cell lymphoma. J Clin Oncol. 2009;27:5594–5600. Presented at: 50th American Society of Hematology Annual 4. Kim SJ, Kim K, Kim BS, et al. Phase II trial of concurrent radia- Meeting & Exposition; December 6-9, 2008; San Francisco, tion and weekly cisplatin followed by VIPD chemotherapy in CA. Blood. 2008;112:Abstract 579.

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