Azacitidine Plus Romidepsin Treatment for PTCL Effective in Real-World Setting

Epigenetic therapy with azacitidine and romidepsin for patients with relapsed peripheral T-cell lymphoma (PTCL) was “highly effective” in a real-world setting, according to investigators of a recent study.

The results of the study, led by Matko Kalac, MD, PhD, of the Icahn School of Medicine at Mount Sinai, were published in the Journal of Clinical Oncology.

Investigators retrospectively identified 17 patients with PTCL who were treated with romidepsin plus subcutaneous azacitidine outside of a clinical trial. Of the patients, 11 had angioimmunoblastic lymphoma, two had adult T-cell leukemia/lymphoma, two had PTCL with a follicular helper, one had PTCL-not otherwise specified, and one had composite lymphoma. The median patient age was 63 years, and patient shad received a median of four treatment cycles (range, 1-12 cycles).

Next-generation sequencing data were available for 10 patients. TET2 mutations were reported in seven patients, RHOA mutations in four patients, IDH2 mutations in three patients, and DNMT3A mutations in one patient. One adult T-cell leukemia/lymphoma patient had mutations in TRAF3, FAT1, and MED12.

Recurrent mutations in genes encoding epigenetic factors, such as TET2, DNMT3A, and IDH2, “may contribute to PTLC vulnerability to epigenetic drugs” such as azacitidine, a demethylating agent, and romidepsin, a histone deacetylase inhibitor, the study’s authors wrote.

The overall response rate was 76%, and the complete response (CR) rate was 52%. Azacitidine and romidepsin were used to achieve remission prior to allogeneic transplant in four patients, all of whom were in CR at their most recent disease assessment.

“Subcutaneous azacitidine and romidepsin administered in a ‘real-world’ situation is highly effective in patients with relapsed PTCL with tolerable toxicity and can be used to successfully bridge patients to stem cell transplant,” investigators concluded.

Kalac M, Tam CSL, Goldfinger M, et al. A real-world experience of combined treatment with romidepsin and azacitidine in patients with peripheral T-cell lymphoma. J Clin Oncol. 2022;40(16_suppl):e19550-e19550.