Phase II study of sequential chemoradiotherapy with L-asparaginase, dexamethasone, ifosfamide, cisplatin, and etoposide (DICE-L) in the early stage of extranodal natural killer (NK)/T-cell lymphoma

Yao Zhang; Yizhen Liu; Zuguang Xia; Jia Jin; Kai Xue; Jiachen Wang; Hui Sun; Fangfang Lv; Xiaojian Liu; Junning Cao; Xiaonan Hong; Ye Guo; Xuejun Ma; Qunling Zhang

doi:10.21037/atm-21-3525

Phase II study of sequential chemoradiotherapy with L-asparaginase, dexamethasone, ifosfamide, cisplatin, and etoposide (DICE-L) in the early stage of extranodal natural killer (NK)/T-cell lymphoma

Ann Transl Med. 2021 Jul;9(14):1178. doi: 10.21037/atm-21-3525.

Authors

Yao Zhang^{1

2}, Yizhen Liu^{1

2}, Zuguang Xia^{1

2}, Jia Jin^{1

2}, Kai Xue³, Jiachen Wang^{1

2}, Hui Sun^{1

2}, Fangfang Lv^{1

2}, Xiaojian Liu^{1

2}, Junning Cao^{1

2}, Xiaonan Hong^{1

2}, Ye Guo⁴, Xuejun Ma⁵, Qunling Zhang^{1

2}

Affiliations

¹ Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
² Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
³ Department of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁴ Department of Medical Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
⁵ Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.

Abstract

Background: To explore a more effective treatment strategy for newly diagnosed stage I and II extranodal natural killer/T-cell lymphoma (ENKTL), nasal type, we conducted a prospective phase II study of sequential chemoradiotherapy with the L-asparaginase, dexamethasone, ifosfamide, cisplatin, and etoposide (DICE-L) regimen.

Methods: Patients with newly diagnosed stage I and II ENKTL in the upper-aerodigestive tract were enrolled. Treatment was comprised of up to 4 cycles of DICE-L followed by 50 Gy of intensity modulated radiation therapy (IMRT) to the involved field. The primary endpoint was the complete response (CR) rate. The secondary endpoints were the objective response rate (ORR), the 5-year overall survival (OS) rate, the 5-year progression-free survival (PFS) rate, and safety.

Results: A total of 81 patients were enrolled from June 2009 to May 2012 in Shanghai Cancer Hospital. Among these patients, 68 patients achieved CR and 1 patient achieved partial response (PR). The CR rate was 84%, and the ORR was 85.2%. With a median follow up of 88.1 months, the 5-year OS and 5-year PFS rates were 82.4% and 63.4%, respectively. The most common adverse events were grade 3 to 4 neutropenia (73.5%) and febrile neutropenia (21%).

Conclusions: Sequential chemoradiotherapy using DICE-L followed by radiotherapy is an effective treatment modality for stage I to IIE ENKTL and is safe with acceptable toxicity.

Keywords: Extranodal natural killer/T-cell lymphoma (ENKTL); L-asparaginase; dexamethasone, ifosfamide, cisplatin, and etoposide (DICE); sequential chemoradiotherapy.