The panel discuss the potential of targeted treatments to replace current standard CHOP chemotherapy for T-cell lymphoma. Positive results from research into histone deacetylase (HDAC) inhibitors and anecdotal evidence to support the use of romidepsin have emphasised this potential, yet understanding of T-cell lymphoma is still lagging behind Hodgkin’s, follicular and diffuse large B-cell lymphoma. A key factor inhibiting the development of treatments is the rarity and large number of different subtypes in this disease. The panel suggest this would be overcome if biopsies were taken more frequently to increase our knowledge of the genetic basis for this disease.
The end point for clinical trials has traditionally been overall survival, however, the relatively long life history of haematological cancers mean that this cannot be used to quickly detect improvements in efficacy. Prof Wyndham Wilson proposes that clinical benefit would be a more appropriate measure and explains that it is important to weigh up the degree of biological benefit against any cost to patient quality of life. Prof Wilson concludes the discussion by outlining alternative end points and ways of evaluating clinical trials when randomised designs are not feasible.