A phase ii study of ifosfamide, Methotrexate, Etoposide, And prednisolone for previously untreated stage i/ii extranodal natural killer/t-cell lymphoma, Nasal type

A multicenter trial of the korean cancer study group

Tae Min Kim, Dong Wan Kim, Yoon Koo Kang, Jooseop Chung, Hong Suk Song, Hyo Jung Kim, Byung Soo Kim, Jong Seok Lee, Hawk Kim, Sung Hyun Yang, Young Jin Yuh, Sung Hwa Bae, Myung Soo Hyun, Yoon Kyung Jeon, Chul Woo Kim, Dae Seog Heo

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Abstract

Background. Combination chemotherapy consisting of ifosfa-mide, methotrexate, etoposide, and prednisolone (IMEP) was active as first-line and second-line treatment for extranodal natural killer/T-cell lymphoma (NTCL).

Methods. Forty-four patients with chemo-na¨ve stage I/IINTCL were enrolled in a prospective, multicenter, phase II study and received six cycles of IMEP (ifosfamide 1.5 g/m2 on days 1-3; methotrextate 30 mg/m2 on days 3 and 10; etoposide 100 mg/m2 on days 1-3; and prednisolone 60 mg/m2 per day on days 1-5) followed by involved field radiotherapy (IFRT).

Results. Overall response rates were 73% (complete remission [CR] in 11 of 41 evaluable patients [27%]) after IMEP chemotherapy and 78% (CR 18 of 27 evaluable patients [67%]) after IMEP followed by IFRT. Neutropenia and thrombocytopenia were documented in 33 patients (75%) and 7 patients (16%), respectively. Only 8 patients (18%) experienced febrile neutropenia. Three-year progression-free survival (PFS) and overall survival (OS) were 66% and 56%, respectively. High Ki-67 (>70%) and Ann Arbor stage II independently reduced PFS (p =.004) and OS (p =.001), respectively.

Conclusion. Due to the high rate of progression during IMEP chemotherapy, IFRT needs to be introduced earlier. Moreover, active chemotherapy including an L-asparaginase-based regimen should be use to reduce systemic treatment failure in stage I/II NTCL.

Original languageEnglish
Pages (from-to)1129-1130
Number of pages2
JournalOncologist
Volume19
Issue number11
DOIs
Publication statusPublished - 2014 Jan 1

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Ifosfamide
Etoposide
Prednisolone
Nose
Methotrexate
Natural Killer Cells
Multicenter Studies
Lymphoma
Neoplasms
Natural Killer T-Cells
Radiotherapy
T-Cell Lymphoma
Drug Therapy
Disease-Free Survival
Asparaginase
Febrile Neutropenia
Survival
Combination Drug Therapy
Neutropenia
Treatment Failure

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A phase ii study of ifosfamide, Methotrexate, Etoposide, And prednisolone for previously untreated stage i/ii extranodal natural killer/t-cell lymphoma, Nasal type : A multicenter trial of the korean cancer study group. / Kim, Tae Min; Kim, Dong Wan; Kang, Yoon Koo; Chung, Jooseop; Song, Hong Suk; Kim, Hyo Jung; Kim, Byung Soo; Lee, Jong Seok; Kim, Hawk; Yang, Sung Hyun; Yuh, Young Jin; Bae, Sung Hwa; Hyun, Myung Soo; Jeon, Yoon Kyung; Kim, Chul Woo; Heo, Dae Seog.

In: Oncologist, Vol. 19, No. 11, 01.01.2014, p. 1129-1130.

Research output: Contribution to journalArticle

Kim, Tae Min ; Kim, Dong Wan ; Kang, Yoon Koo ; Chung, Jooseop ; Song, Hong Suk ; Kim, Hyo Jung ; Kim, Byung Soo ; Lee, Jong Seok ; Kim, Hawk ; Yang, Sung Hyun ; Yuh, Young Jin ; Bae, Sung Hwa ; Hyun, Myung Soo ; Jeon, Yoon Kyung ; Kim, Chul Woo ; Heo, Dae Seog. / A phase ii study of ifosfamide, Methotrexate, Etoposide, And prednisolone for previously untreated stage i/ii extranodal natural killer/t-cell lymphoma, Nasal type : A multicenter trial of the korean cancer study group. In: Oncologist. 2014 ; Vol. 19, No. 11. pp. 1129-1130.
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abstract = "Background. Combination chemotherapy consisting of ifosfa-mide, methotrexate, etoposide, and prednisolone (IMEP) was active as first-line and second-line treatment for extranodal natural killer/T-cell lymphoma (NTCL).Methods. Forty-four patients with chemo-na¨ve stage I/IINTCL were enrolled in a prospective, multicenter, phase II study and received six cycles of IMEP (ifosfamide 1.5 g/m2 on days 1-3; methotrextate 30 mg/m2 on days 3 and 10; etoposide 100 mg/m2 on days 1-3; and prednisolone 60 mg/m2 per day on days 1-5) followed by involved field radiotherapy (IFRT).Results. Overall response rates were 73{\%} (complete remission [CR] in 11 of 41 evaluable patients [27{\%}]) after IMEP chemotherapy and 78{\%} (CR 18 of 27 evaluable patients [67{\%}]) after IMEP followed by IFRT. Neutropenia and thrombocytopenia were documented in 33 patients (75{\%}) and 7 patients (16{\%}), respectively. Only 8 patients (18{\%}) experienced febrile neutropenia. Three-year progression-free survival (PFS) and overall survival (OS) were 66{\%} and 56{\%}, respectively. High Ki-67 (>70{\%}) and Ann Arbor stage II independently reduced PFS (p =.004) and OS (p =.001), respectively.Conclusion. Due to the high rate of progression during IMEP chemotherapy, IFRT needs to be introduced earlier. Moreover, active chemotherapy including an L-asparaginase-based regimen should be use to reduce systemic treatment failure in stage I/II NTCL.",
author = "Kim, {Tae Min} and Kim, {Dong Wan} and Kang, {Yoon Koo} and Jooseop Chung and Song, {Hong Suk} and Kim, {Hyo Jung} and Kim, {Byung Soo} and Lee, {Jong Seok} and Hawk Kim and Yang, {Sung Hyun} and Yuh, {Young Jin} and Bae, {Sung Hwa} and Hyun, {Myung Soo} and Jeon, {Yoon Kyung} and Kim, {Chul Woo} and Heo, {Dae Seog}",
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T1 - A phase ii study of ifosfamide, Methotrexate, Etoposide, And prednisolone for previously untreated stage i/ii extranodal natural killer/t-cell lymphoma, Nasal type

T2 - A multicenter trial of the korean cancer study group

AU - Kim, Tae Min

AU - Kim, Dong Wan

AU - Kang, Yoon Koo

AU - Chung, Jooseop

AU - Song, Hong Suk

AU - Kim, Hyo Jung

AU - Kim, Byung Soo

AU - Lee, Jong Seok

AU - Kim, Hawk

AU - Yang, Sung Hyun

AU - Yuh, Young Jin

AU - Bae, Sung Hwa

AU - Hyun, Myung Soo

AU - Jeon, Yoon Kyung

AU - Kim, Chul Woo

AU - Heo, Dae Seog

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background. Combination chemotherapy consisting of ifosfa-mide, methotrexate, etoposide, and prednisolone (IMEP) was active as first-line and second-line treatment for extranodal natural killer/T-cell lymphoma (NTCL).Methods. Forty-four patients with chemo-na¨ve stage I/IINTCL were enrolled in a prospective, multicenter, phase II study and received six cycles of IMEP (ifosfamide 1.5 g/m2 on days 1-3; methotrextate 30 mg/m2 on days 3 and 10; etoposide 100 mg/m2 on days 1-3; and prednisolone 60 mg/m2 per day on days 1-5) followed by involved field radiotherapy (IFRT).Results. Overall response rates were 73% (complete remission [CR] in 11 of 41 evaluable patients [27%]) after IMEP chemotherapy and 78% (CR 18 of 27 evaluable patients [67%]) after IMEP followed by IFRT. Neutropenia and thrombocytopenia were documented in 33 patients (75%) and 7 patients (16%), respectively. Only 8 patients (18%) experienced febrile neutropenia. Three-year progression-free survival (PFS) and overall survival (OS) were 66% and 56%, respectively. High Ki-67 (>70%) and Ann Arbor stage II independently reduced PFS (p =.004) and OS (p =.001), respectively.Conclusion. Due to the high rate of progression during IMEP chemotherapy, IFRT needs to be introduced earlier. Moreover, active chemotherapy including an L-asparaginase-based regimen should be use to reduce systemic treatment failure in stage I/II NTCL.

AB - Background. Combination chemotherapy consisting of ifosfa-mide, methotrexate, etoposide, and prednisolone (IMEP) was active as first-line and second-line treatment for extranodal natural killer/T-cell lymphoma (NTCL).Methods. Forty-four patients with chemo-na¨ve stage I/IINTCL were enrolled in a prospective, multicenter, phase II study and received six cycles of IMEP (ifosfamide 1.5 g/m2 on days 1-3; methotrextate 30 mg/m2 on days 3 and 10; etoposide 100 mg/m2 on days 1-3; and prednisolone 60 mg/m2 per day on days 1-5) followed by involved field radiotherapy (IFRT).Results. Overall response rates were 73% (complete remission [CR] in 11 of 41 evaluable patients [27%]) after IMEP chemotherapy and 78% (CR 18 of 27 evaluable patients [67%]) after IMEP followed by IFRT. Neutropenia and thrombocytopenia were documented in 33 patients (75%) and 7 patients (16%), respectively. Only 8 patients (18%) experienced febrile neutropenia. Three-year progression-free survival (PFS) and overall survival (OS) were 66% and 56%, respectively. High Ki-67 (>70%) and Ann Arbor stage II independently reduced PFS (p =.004) and OS (p =.001), respectively.Conclusion. Due to the high rate of progression during IMEP chemotherapy, IFRT needs to be introduced earlier. Moreover, active chemotherapy including an L-asparaginase-based regimen should be use to reduce systemic treatment failure in stage I/II NTCL.

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