JSCO2016: International Session 13 Malignant Lymphoma

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The 54th Annual Meeting of Japan Society of Clinical Oncology (JSCO2016)

"Renovation of Cancer Medicine in the Mature Society"



International Session 1: Lung Cancer
International Session 2: Colorectal Cancer
International Session 3: Gastric Cancer
International Session 4: Urological Cancer (Prostate and Renal Cancer)
International Session 5: Supportive Care for Adverse Events
International Session 6: Gynecological Cancer (Uterine Body Cancer and Ovarian Cancer)
International Session 7: Central Nervous System Tumor
International Session 8: New Development of Particle Beam Therapy for Cancer
International Session 9: International Cooperation in Radiation Medicine
International Session 10: Recent Advances In Cancer Immunotherapy
International Session 11: Breast Cancer
International Session 12: Pharmacology of Antitumor Agents: New Drug Application (NDA)
International Session 13: Malignant Lymphoma
International Session 14: Palliative Care
International Session 15: Radiation Therapy
International Session 16: Head and Neck Cancer
International Session 17: Skin Cancer (Malignant Melanoma)
International Session 18: Hepato-Biliary and Pancreas Cancers
International Session 19: Leukemia
International Session 20: Ethics for Clinical Research
International Session 21: Esophageal Cancer
International Session 22: Bone and Soft Tissue Tumor
FACO/JSCO Joint Symposium

Abstract Archives (in Japanese)

International Session 13: Malignant Lymphoma


Current treatment guidelines for malignant lymphoma in Japan
Yukio Kobayashi (Hematology Division, National Cancer Center Hospital)
Japanese guidelines for the treatment of hematological malignancies were published in 2013 under the auspices of the Japan Hematology Association. The section on malignant lymphoma describes the nine most common subtypes of malignant lymphoma and their recommended treatment options. These guidelines demonstrate significant differences from National Comprehensive Cancer Network (NCCN) and National Cancer Institute (NCI) PDQ guidelines reflecting differences in the availability of commercial drugs, and in increased frequencies of subtypes such as natural killer/T cell lymphoma and adult T cell lymphoma in Japan.
The sections on B cell malignancies describe follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), mantle cell lymphoma (MCL), Burkitt lymphoma, lymphoplasmacytic lymphoma (LpL), and mucosa-associated lymphoid tissue (MALT) lymphoma in relation to their stages, age, and situation. Regarding FL, the stage of disease determines the timing of therapy and the use of radiotherapy; involved-field radiotherapy is recommended as first-line treatment in cases of limited-stage FL, while chemotherapy is recommended for advanced-stage FL. The Japanese guidelines are in accordance with the NCCN and NCI guidelines in terms of DLBCL. Although novel agents recently approved for MCL and LpL in Japan are not included in the current guidelines, they are likely to be added to the next version. Regarding Hodgkin's lymphoma, ABVD rather than BEACOPP is currently the standard therapy for advanced-stage disease, with the latter still under investigation.
The current version of the guidelines regarding T cell malignancies do not mention the availabilities of the toxin-conjugated CD30 antibody, brentuximab vedotin, and the anti-CCR4 antibody, mogamulizumab, as investigational drugs, though these are sure to be included in the next version.


Update on novel therapies for Hodgkin and Non-Hodgkin lymphoma
Julie M. Vose (Internal Medicine, Division of Oncology & Hematology, University of Nebraska, USA)
The treatment options for Hodgkin lymphoma had not changed very much until a few years ago when brentuximab vedotin was approved for treatment of patients who had failed standard chemotherapy with or without failure of an autologous stem cell transplantation. Recent studies are evaluating the use of brentuximab vedotin for use in upfront therapy in combinations or for older patients, or for use as a maintenance therapy post-transplant in higher risk patients. More recently, there has been excitement for studies evaluating immunotherapy for relapsed Hodgkin lymphoma. Both nivolumab and pembrolizumab have a high response rate for relapsed Hodgkin lymphoma and they are now being evaluated in combination trials.
For non-Hodgkin lymphoma, most of the excitement over the last few years has been in evaluating pathway targeted agents in specific subtypes of lymphoma where that pathway is known to be an active target. In addition, many of these agents are also being evaluated in combination trials with standard chemotherapy, monoclonal antibody therapy, and/or immunotherapy. Examples of pathway targeted agents with new data include ibrutinib, idelalisib, or other B-cell pathway agents that target pathways at different spots. These agents are also being combined with nivolumab or pembrolizumab in some types of non-Hodgkin lymphoma which is leading to some exciting responses. Areas of active research will try to understand which lymphomas are most susceptible to specific types of therapies. This will include specific genomic assays so that we can better understand the types of lymphomas and the response patterns of all types of therapies.


Radiation therapy in malignant lymphomas
Mary K. Gospodarowicz (Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Canada)
Radiation therapy has been used in the management of malignant lymphoid malignancies for close to a century. The first cures of lymphomas were observed with radiotherapy well before chemotherapy was developed. Most lymphoid malignancies are very radiosensitive and moderate doses of radiotherapy result in a durable local control. However, most lymphomas even when localized at presentation are associated with occult systemic disease and distant recurrence after local radiotherapy is common. Therefore with the development of effective chemotherapy, systemic treatment approach is now the mainstay of the management for most lymphomas. With increasing efficacy of chemotherapy and targeted therapy, the role of chemotherapy has been redefined. In large cell lymphomas, chemotherapy is the primary modality. Radiotherapy is used to improve local control and survival in localized disease and improve local control or for palliation in advanced disease.

Radiotherapy has been documented to be able to cure localized lymphomas. Currently, for follicular and marginal zone lymphomas cure is only available with radiotherapy for localized disease. With the use of moderate dose radiotherapy and modern radiotherapy techniques, the acute and late toxicity is well tolerated by most patients. The technical aspects of treatment planning for lymphomas are highly dependent on the location and extent of the target volume. In most cases, established techniques for cancer of other anatomic sites are adapted to lymphomas.


Malignant lymphoma: Year in review in Asia or Japan
Hirokazu Nagai (Clinical Research Center, National Hospital Organization Nagoya Medical Center)
The incidence of mature T cell lymphomas is relatively higher in Japan and Asia than in western countries. T cell lymphoma often shows resistance to conventional chemotherapies, and therefore development of new treatments is eagerly awaited. Recent advances as outlined below have been made in the treatment of adult T cell leukemia/lymphoma (ATLL), one of the most intractable lymphomas. Mogamulizumab, an anti CCR4 antibody, alone or in combination with chemotherapy, showed favorable efficacy for relapsed ATLL. Recently, a phase II trial of lenalidomide reported that it had promising efficacy in relapsed ATLL. Anti-viral agents are also considered to be good candidates for ATLL treatment in terms of treatment of the HTLV-1 infection of these patients. Thus, the combination of zidovudine, anti-HIV agent, and interferon alfa has been compared to watchful wait strategy to determine the benefit of early intervention in indolent ATLL in Japan Clinical Oncology Group (JCOG) 1111 study. ALK positive anaplastic large cell lymphoma (ALCL) is favorable subtype of T cell lymphoma, but about 30% of these patients require further treatments due to recurrence. Alectinib is an orally administered second-generation ALK inhibitor. Its antitumor effect is exerted through the selective inhibition of ALK, which leads to the inhibition of proliferation and the induction of apoptosis of ALK positive tumor cells. A multi-institutional phase II trial is ongoing in Japan to investigate the efficacy and safety of alectinib for recurrent or refractory ALK-positive ALCL. Forodesine, a purine nucleoside phosphorylase (PNP) inhibitor, and darinaparsin, an arsenical, have been developed against refractory T cell lymphomas, mainly in Asia and Japan. These novel treatments are expected to improve the clinical outcomes of malignant lymphomas.


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