Abstract
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.
Original language | English (US) |
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Pages (from-to) | 476-485 |
Number of pages | 10 |
Journal | Cancer Treatment Reviews |
Volume | 41 |
Issue number | 6 |
DOIs | |
State | Published - Jun 1 2015 |
Keywords
- Chemotherapy
- Mediastinal radiation
- Positron emission tomography
- Primary mediastinal large B-cell lymphoma
- Rituximab
ASJC Scopus subject areas
- Oncology
- Radiology Nuclear Medicine and imaging