Etoposide (VP-16)-Containing Oral Palliative Chemotherapies (OPCs) Are Well Tolerated by Elderly Patients With Aggressive Non-Hodgkin Lymphoma: A 10-Year Single-Institute Experience

TL;DR

Etoposide-based oral chemotherapy is well tolerated and effective in elderly patients with aggressive non-Hodgkin lymphoma.

Contribution

The largest Japanese real-world dataset on etoposide-containing oral palliative chemotherapies for NHL.

Findings

Etoposide-based OPCs were well tolerated with infection as the most common adverse event.

Responding patients had significantly longer event-free survival compared to non-responders.

Some patients benefited from the treatment, allowing longer hospitalization-free periods.

Abstract

Background: Non-Hodgkin lymphoma (NHL) is a malignant neoplasm with lymphoid-cell origin. Some patients are refractory to the treatments. Not all patients with relapsed/refractory NHL can benefit from intensive salvage therapy and novel drugs. Oral palliative chemotherapies (OPCs) are potentially good options for these patients through the alleviation of the lymphoma-related symptoms and the ability to stay at home for longer durations.

Methods: Etoposide (VP-16)-containing OPCs are often used for aggressive NHL as palliative use at our institute. In order to elucidate the toxicity and efficacy of VP-16-OPCs, we retrospectively reviewed the patients at our institute with medical charts. We also reviewed the hospitalization-free period, indicating successful symptom palliation.

Results: Fifty-six patients who received VP-16-OPCs at our institute between April 2012 and December 2023 were reviewed. Diseases include adult T-cell leukemia/lymphoma (ATLL), diffuse large B-cell lymphoma (DLBCL), peripheral T-cell lymphoma (PTCL), and others. VP-16-OPCs include VENP, Sobuzoxane (MST)/VP-16, and VP-16+PSL (prednisolone). Infection was the most common non-hematological adverse event (34%). Nineteen out of 40 patients could complete more than two courses of VENP. Patients who responded to VP-16-OPCs tended to have longer event-free survival (EFS) (46 vs. 268 days, p < 0.01) and hospitalization-free periods (46 vs. 245 days, p = 0.11) compared to those who did not respond.

Conclusion: We here reported the largest Japanese real-world dataset on VP-16-OPCs. The VP-16-OPCs were well tolerated by the patients, and some of them benefited from the treatment. These regimens can be considered when intensive and novel therapies are not indicated.

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