Brentuximab vedotin plus CHP-like versus CHOEP regimen for the first-line treatment of PTCL patients: a multi-center propensity-matched retrospective study

Abstract

The optimal frontline treatment option for Peripheral T-cell lymphomas (PTCLs) has not been completely defined. To compare the efficacy and safety of brentuximab vedotin (BV) combined with CHP-like regimen (cyclophosphamide, an anthracycline component, and prednisone) and CHOEP regimen (cyclophosphamide, doxorubicin, vincristine, prednisone and etoposide) as first-line treatment for newly diagnosed PTCLs, we used 1:1 optimal propensity score-matching (PSM) to match patients by gender, age, disease stage, bone marrow infiltration, extranodal involvement, Eastern Cooperative Oncology Group performance status, and PTCL subtype, resulting in two cohorts of 45 patients each. With a median follow-up of 27.2 months, the 2-year progression-free survival (PFS) rates were 70.7% (95% confidence interval [CI]: 58.5%-85.5%) and 45.3% (95% CI: 32.7%-62.7%) for the BV plus CHP-like and CHOEP groups, respectively (P = 0.012). The 2-year overall survival (OS) rate was 81.0% (95% CI: 68.8%-95.3%) in the BV plus CHP-like group and 75.1% (95% CI: 62.7%-90.1%) in the CHOEP group (P = 0.550). No significant differences were observed between the two groups in complete remission (CR, P = 0.673) and objective response rate (ORR, P = 0.662) at the end-of-follow-up assessment. The duration of response (DOR) in the BV plus CHP-like group was significantly prolonged compared to the CHOEP group (81.9% vs. 63.0%, P = 0.035). In subgroup analysis stratified by ALK expression, no deaths occurred among the 31 ALK-positive ALCL patients; the 2-year PFS rate was 94.4% versus 76.9% (P = 0.066). Among the 59 non-ALK-positive PTCL patients, no significant differences were observed in OS (P = 0.880) or PFS (P = 0.110). BV plus CHP-like regimen was associated with a lower incidence of hematological toxicities than the CHOEP regimen, both for any-grade and for grade ≥ 3 events. The BV plus CHP-like regimen may improve the PFS, without increasing hematological adverse events. However, this benefit was largely offset in non-ALK-positive PTCL patients, and further validation in larger cohorts is warranted.