期刊
CANCER TREATMENT REVIEWS
卷 41, 期 6, 页码 476-485出版社
ELSEVIER SCI LTD
DOI: 10.1016/j.ctrv.2015.04.006
关键词
Primary mediastinal large B-cell lymphoma; Chemotherapy; Rituximab; Mediastinal radiation; Positron emission tomography
类别
资金
- Ziopharm Oncology
- GlaxoSmithKline
- Spectrum Pharmaceuticals
- Roche
- Celgene
- Conatus
The management of primary mediastinal large B-cell lymphoma (PMBCL) requires a balance between optimizing chances of cure and reducing risk of long-term toxicities. The combination of rituximab to cyclophosphamide, doxorubicin, vincristine and prednisone (RCHOP) followed by mediastinal radiation results in a plateau in progression-free survival after first few years of follow-up. In rituximab era, a negative positron emission tomography (PET) scan performed after the completion of immunochemotherapy has a high predictive value for durable remission. Consequently, end-of-therapy PET may be utilizable to avoid radiation without compromising survival. Additionally, intensified chemotherapy alone has shown excellent survival. PMBCL is frequently associated with amplification of programmed death ligand (PDL) 1/2 and constitutive activation of JAK-STAT and NFKB pathways; these may serve as promising therapeutic targets. Clinical trials that integrate novel therapies into upfront immunochemotherapy and utilize end-of-therapy PET scan to guide mediastinal radiation have potential to further enhance survival and prevent long-term toxicities. (C) 2015 Elsevier Ltd. All rights reserved.
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