Successful treatment of an elderly patient with relapsed/refractory angioimmunoblastic T-cell lymphoma with the PI3Kδ inhibitor linperlisib: a Case Report.

in Frontiers in pharmacology by Ming-Qiang Chu, Ting-Juan Zhang, Qian Yang, Yuan Feng, Chao Lu, Yong-Hui Ji, Jun Qian, Jing-Dong Zhou

TLDR

  • Researchers tested a new medicine called linperlisib as a salvage therapy for elderly patients with relapsed/refractory Angioimmunoblastic T-cell lymphoma.
  • The study found linperlisib to be effective and safe in inducing sustained partial remission in this patient population.
  • This new medicine provides a promising alternative to conventional treatment options for elderly patients with AITL who have exhausted prior lines of treatment.

Abstract

Angioimmunoblastic T-cell lymphoma (AITL), a highly aggressive peripheral T-cell lymphoma (PTCL), carries a poor prognosis in elderly patients due to frequent relapse and limited salvage options after multiline therapy. We present the case of an 80-year-old woman with relapsed/refractory (R/R) AITL who relapsed after CHOP and exhibited resistance to the following sequential therapies: second-line chidamide plus COP and third-line chidamide with mitoxantrone hydrochloride liposome. Molecular analysis revealedandmutations, reflecting disease complexity. Salvage therapy with linperlisib, a selective PI3Kδ inhibitor, combined with gemcitabine/oxaliplatin induced sustained partial remission, followed by linperlisib maintenance. The regimen demonstrated exceptional safety, with no grade ≥2 toxicities, even in this frail population. This case highlights the dual role of linperlisib as an effective and well-tolerated therapy for elderly R/R AITL patients who have exhausted prior lines. By precisely targeting PI3Kδ, our findings offer critical real-world evidence to address the unmet need for safe salvage strategies in this vulnerable population.

Overview

  • The study focuses on the treatment of relapsed/refractory Angioimmunoblastic T-cell lymphoma (AITL) in an 80-year-old woman who failed multiple lines of therapy.
  • The patient's cancer showed resistance to chinidamide plus COP and chinidamide with mitoxantrone hydrochloride liposome, prompting the use of linperlisib, a selective PI3Kδ inhibitor.
  • The study aims to evaluate the efficacy and safety of linperlisib as a salvage therapy for elderly AITL patients who have exhausted prior lines of treatment.

Comparative Analysis & Findings

  • The patient relapsed after initial therapy with CHOP and exhibited resistance to multiple subsequent lines of therapy, highlighting the need for alternative salvage options.
  • Molecular analysis revealed and mutations, indicating the complexity of the disease.
  • The combination of linperlisib with gemcitabine and oxaliplatin induced sustained partial remission, with no grade ≥2 toxicities, demonstrating exceptional safety and efficacy in this frail patient population.

Implications and Future Directions

  • The study highlights linperlisib as a potential salvage therapy for elderly R/R AITL patients who have exhausted prior lines of treatment, offering a promising alternative to conventional treatment options.
  • The findings provide critical real-world evidence for the use of linperlisib in this vulnerable patient population, addressing the unmet need for safe salvage strategies.
  • Future studies should investigate the use of linperlisib in earlier lines of treatment and explore its combination with other therapies to improve outcomes in AITL patients.
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