Expert Perspectives in Lymphoma - Episode 7

Primary Cutaneous T-cell Lymphoma: ALCANZA Trial

Stephen M. Ansell, MD, PhD: Cutaneous T-cell lymphoma is a disease that predominantly involves the skin. It can often be CD30-positive. The ALCANZA study tested whether CD30-directed therapy would be better than standard treatment. In this study, patients were randomized to receive brentuximab vedotin or a standard therapy—either bexarotene or methotrexate. The results showed and previously reported that there was a significant advantage for patients receiving the brentuximab vedotin combination over the standard treatment.

The longer-term follow up confirmed that these results continue to be quite excellent. Additional data that are very interesting reveal that patients symptomatically improved quite significantly, too. So, it’s all fine and well to control the disease, but if the patients still have substantial symptoms, that remains to be a problem. But, in this case, this showed that the patients not only clinically improved but symptomatically improved, as well.

Radhakrishnan Ramchandren, MD: This was a follow-up of the ALCANZA study. The study revealed a significant benefit in terms of response and duration of response in this population. Importantly, in longer-term follow-up of almost 34 months, these results persisted. This suggested that brentuximab vedotin is not only an active agent but also that activity results in durability of response. Given that this population has few treatment options, identifying potential patients with durability is important. These patients essentially have an incurable disease, by and large. Identifying agents that prolong disease response and, hopefully, someday survival would be critical.

The role of CD30 testing in T-cell lymphoma is important. There are many different types of T-cell lymphomas. In those who have CD30 positivity, brentuximab vedotin may be an agent with activity. At our own institution, we test all T-cell lymphomas for CD30 presence. The exact cutoffs, or positivity and negativity, have not been well established. But, in patients who have CD30 positivity, brentuximab vedotin may be an option. This includes not only patients with anaplastic large-cell lymphoma but also other T-cell subsets that may express CD30 in their own populations. Therefore, identifying those patients may provide an option for an effective therapeutic agent. So, in general, I would recommend that patients who have T-cell lymphoma be evaluated for CD30 if at all possible.

Transcript Edited for Clarity