Oncology Frontier: What are the therapeutic options in relapsed or refractory peripheral T-cell lymphoma at present?

　　《肿瘤瞭望》：目前治疗难治和复发的外周T细胞淋巴瘤有哪些策略？

　　Dr Piccaluga: This is another relevant and difficult issue. If you ask ten physicians involved with lymphoma treatment， you will get fifteen different regimens. We actually don’t have an official treatment for relapsed patients. As indicated in the guidelines by the NCCN or European guidelines， we don’t have a single combination as a reference， so different schemes can be applied. Importantly， in the last five years， three new molecules have been approved in the US and two of them in Europe for the treatment of relapsed cancer. A different one was registered in Japan. Those drugs include pralatrexate， a conventional chemotherapy even though it is a new molecule. Then we have romidepsin， a histone deacetylase inhibitor， so a drug targeting the epigenome of the tumor and genetic lesions are very relevant in the biology of peripheral T-cell lymphomas. Last， but not least， brentuximab vedotin， a monoclonal antibody targeting CD30 combined with a potent cytotoxic molecule and which is indicated for anaplastic large cell lymphoma. It is now being evaluated in other CD30-positive tumors. So all of these three are now under evaluation in clinical trials in combination with chemotherapy in the first-line setting.

　　Piccaluga教授：这是目前的一个难题。如果你问十位从事淋巴瘤治疗的医生，你会得到十多种不同的治疗方案。事实上，对于复发患者，我们并没有常规的治疗方案。目前NCCN和欧洲指南均没有提供一个标准性的推荐，因此临床医生可能采用不同的治疗方案。在过去的五年里，有三种新药已被美国FDA批准使用，其中有两种在欧洲用于治疗复发癌，另一种已在日本注册使用。这些药物是：①pralatrexate，虽然它是一个新分子，但是一种传统的化疗药；②罗米地辛，它是一种组蛋白去乙酰化酶抑制剂，可作用于肿瘤和与外周T细胞淋巴瘤密切相关的生物学遗传性病变的表观基因组；③brentuximab vedotin，是CD30的一种单克隆抗体，CD30可与细胞毒性分子结合，并且是间变性大细胞淋巴瘤的分子标志物。以上这三种药物正处于联合化疗的Ⅰ线临床试验阶段。