Source: http://oncologychina.blogspot.ca/2015/02/will-p-gemox-regimen-make-cut-for.html
Arrived on the Horizon
It was December 9, American Society of Hematology/Oncology (ASH) 2013, Prof. Huang Huiqiang, MD, PhD, Cancer Center, Sun Yat-sen University, Guangzhou, China, who first introduced Peg-ASP-Gemox (P-GEMOX) regimen in the treatment of newly diagnosed or relapsed extranodal NK/T cell lymphoma (ENKTL) to the world.
Compared with the recommended regimens from National Comprehensive Cancer Network (NCCN), P-GEMOX is not only "highly effective, but also safer and easier to use. It will be suitable for wide recommendation," according to Prof. Huang.
Prof. Huang at the ASH 2013
How is P-GEMOX?
P stands for PEG-Asparaginase; Gem stands for Gemcitabine and OX stands for Oxliplatin.
In his single center clinical trial, 36 newly diagnosed and 25 refractory and relapsed extranodal NK/T cell lymphoma patients were enrolled. The outcome: The median follow-up was 29.5 months; The 2-year overall survival was 86%; The overall response rate (ORR) was 90%.
Among newly diagnosed patients, the ORR was 94.3% (In the early stage IE/IIE patients, the 2 year overall survival and progression free rate is 100% and 87.1%, respectively), and among the relapsed/refractory patients, the ORR was 84%.
The blue line=early stage patients; the green line=relapse or refractory patients. Also see Abstract 642 in ASH 2013.
Please also refer "Regimen shows promise for ENKTL" from Hematolgoytimes.com for more detailed coverage of this P-GEMOX trial.
From Prof. Huang's experience, compared with SMILE and AspaMetDex regimens, P-GEMOX or Peg-Asp GemOx is as good as them in efficacy, yet, with much less side effects. Also, P-GEMOX can be administrated in outpatient clinic setting, so patients don't have to stay in the hospital for the high dose MTX administration repeated monitoring of blood content and forced hydration, which are complicated and troublesome. Furthermore, P-GEMOX is more cost-effective.
Why is P-GEMOX?
"I remember when I first started to use SMILE to treat ENKTL patients, my impression was its side effect was too much. I still have strong memory that all SMILE patients were unable to be discharged. The patients needed all kinds of medicines for support treatment to counterpart its side effects."
"Facing many ENKTL patients in my daily clinical practice, I need to be creative to find solutions for them."
"Started from just experiment to reduce SMILE dosage, then I began to try new drugs into treatment. With the help of our team, I discovered P-GEMOX."
A True Patient's Story
"In 2011, Damei, a 29 year old lady with advanced NK/T cell Lymphoma came to my ward. Many hospitals refused to take her because she was too sick."
"With a large abdominal tumor, intestine fistula, she was in very dangerous situation. She needed urgent intervention. So we considered only P-GEMOX with mild side effect profile would be best care for her."
"After have been suffered so many hardiness in her life, this poor county girl might have been blessed by heaven. Like a miracle, the tumor disappeared completely after P-GEMOX treatment! Damei is still quite well and tumor- free approximately 2 years after autologous peipheral stem cell transplantation as consolidation treatment."
"From this experience, I was able to experience the pride and satisfaction as a doctor, to save life."
After recovery, Damei is now working as a Patient's guide in Cancer Center.
Rise to the Global Stage
ASH 2013 conference was a turning point for Prof. Huang's global role in NK/T cell lymphoma. Yet, before that, he has been kept submitting papers to ASH for several years without any invitation.
In 2014, he was invited to share his experience on P-GEMOX at 6th T-Cell Lymphoma Forum, and in Feb. 2015, at 7th T-Cell Lymphoma Forum, he presented "PET/CT in the management of ENKTL".
In Apr. 2015, he has been invited first time, to share his experience on ENKTL management at T-cell Lymphoma Meeting held in Bologna, Italy.
Prof. Huang at the 7th T-Cell Lymphoma Forum
Next Step to Make the Big Star
Prof. Huang's P-GEMOX has shown superior qualities in the treatment of ENKTL from his experience, other Chinese peers clinical pursuits, such as Prof. Liu Xia and He Junqiao, and in his single center trial.
P-GEMOX has triggered much attention in the ENKTL treatment specialist scouts around the globe. But can it prove its efficacy and safety in larger, multi-centered, randomized clinical trials? Prof. Huang has already initiated a phase III, multi-centered, randomized clinical trial in China recently, and on his way to prove the answer for others.
