A case of cutaneous peripheral T-cell Lymphoma not otherwise specified (PTCL-NOS), successfully treated with Brentuximab Vedotin after disease progression on standard chemotherapy
Poster
Cutaneous PTCL-NOS is a rare and aggressive variant of cutaneous T-cell lymphoma with unfavourable prognosis. First line treatment includes anthracycline based regimens. However, the disease tends to be refractory to chemotherapy and patients relapse very quickly.
We present a case of cutaneous PTCL-NOS, follicular T-helper phenotype, CD30+, successfully treated with Brentuximab Vedotin after rapid progression under two standard chemotherapy regimens and TSEBT.
The baseline PET/CT in May 2020 (prior to cycle 1 of Brentuximab) showed metabolically active subcutaneous nodules throughout the body, with muscle involvement in both legs.
The patient already had 2 lines of chemotherapy including CHOP with progressive multiple focal lesions following cycle 4. The treatment was switched to GCVP – 4 cycles completed 15.08.19 - after which she had further progression. The only available treatment options were either gemcitabine/oxaliplatin containing chemotherapy or CEPP regimen (cyclophosphamide, etoposide, procarbazine, prednisolone). Both treatments had a low chance to be beneficial, considering the rapid progression on the previous two chemotherapy lines.
In view of the CD30 positivity (more than 30%) we considered treatment with Brentuximab Vedotin, which we obtained as compassionate use supply.
We started treatment in September 2020 and a restaging PET/CT showed partial response after cycle 4 and complete metabolic response after cycle 8. The patient was still free from recurrence after cycle 15.
The treatment tolerance was excellent with only G1-G2 peripheral neuropathy. There was one episode of G3 peripheral neuropathy post cycle 10, which improved back to G1 after giving 2 weeks break from treatment.
PTCL NOS is characterised by poor overall survival (20-30% at 5 years) and rapid progression. The treatment with Brentuximab Vedotin has proven to be safe and effective in our patient, with maintained response at 12 months after treatment initiation.
We present a case of cutaneous PTCL-NOS, follicular T-helper phenotype, CD30+, successfully treated with Brentuximab Vedotin after rapid progression under two standard chemotherapy regimens and TSEBT.
The baseline PET/CT in May 2020 (prior to cycle 1 of Brentuximab) showed metabolically active subcutaneous nodules throughout the body, with muscle involvement in both legs.
The patient already had 2 lines of chemotherapy including CHOP with progressive multiple focal lesions following cycle 4. The treatment was switched to GCVP – 4 cycles completed 15.08.19 - after which she had further progression. The only available treatment options were either gemcitabine/oxaliplatin containing chemotherapy or CEPP regimen (cyclophosphamide, etoposide, procarbazine, prednisolone). Both treatments had a low chance to be beneficial, considering the rapid progression on the previous two chemotherapy lines.
In view of the CD30 positivity (more than 30%) we considered treatment with Brentuximab Vedotin, which we obtained as compassionate use supply.
We started treatment in September 2020 and a restaging PET/CT showed partial response after cycle 4 and complete metabolic response after cycle 8. The patient was still free from recurrence after cycle 15.
The treatment tolerance was excellent with only G1-G2 peripheral neuropathy. There was one episode of G3 peripheral neuropathy post cycle 10, which improved back to G1 after giving 2 weeks break from treatment.
PTCL NOS is characterised by poor overall survival (20-30% at 5 years) and rapid progression. The treatment with Brentuximab Vedotin has proven to be safe and effective in our patient, with maintained response at 12 months after treatment initiation.