Medication Summary

Cancer chemotherapy is based on an understanding of tumor cell growth and on how drugs affect this growth. After cells divide, they enter a period of growth (phase G1), followed by DNA synthesis (phase S), the premitotic phase (phase G2), and, finally, mitotic cell division (phase M).

Cell division rates vary for different tumors. Most common cancers grow slowly in comparison with normal tissues, and the growth rate may decrease further in large tumors. This difference allows normal cells to recover from chemotherapy more quickly than malignant cells, and it is the rationale for current cyclic dosage schedules.

Today, most patients are treated with the chemotherapy regimen known as CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) in conjunction with radiotherapy.

Class Summary

Antineoplastic agents interfere with cell reproduction. Some agents are cell cycle–specific, whereas others (eg, alkylating agents, anthracyclines, and cisplatin) are not phase-specific. Cellular apoptosis (ie, programmed cell death) is another potential mechanism of many antineoplastic agents.

Cyclophosphamide

View full drug information

Cyclophosphamide alkylates and cross-links DNA.

Doxorubicin (Adriamycin)

View full drug information

Doxorubicin is an anthracycline. Its multiple mechanisms of action involve DNA intercalation, topoisomerase-mediated DNA strand breakage, and oxidative damage due to free radical production.

Vincristine (Vincasar PFS)

View full drug information

Vincristine inhibits microtubule formation in the mitotic spindle, causing metaphase arrest.

Prednisone

View full drug information

Prednisone is an immunosuppressant used for treatment of autoimmune disorders. It may decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear leukocyte (PMN) activity.

Questions

Wang H, Fu BB, Gale RP, Liang Y. NK-/T-cell lymphomas. Leukemia. 2021 Jun 11. [QxMD MEDLINE Link]. [Full Text].
Thida AM, Gohari P. Extranodal NK-Cell Lymphoma. StatPearls. 2021 Jan. [QxMD MEDLINE Link]. [Full Text].
Jaffe ES, Nicolae A, Pittaluga S. Peripheral T-cell and NK-cell lymphomas in the WHO classification: pearls and pitfalls. Mod Pathol. 2013 Jan. 26 Suppl 1:S71-87. [QxMD MEDLINE Link].
Borges A, Fink J, Villablanca P, Eversole R, Lufkin R. Midline destructive lesions of the sinonasal tract: simplified terminology based on histopathologic criteria. AJNR Am J Neuroradiol. 2000 Feb. 21(2):331-6. [QxMD MEDLINE Link].
Ooi GC, Chim CS, Liang R, Tsang KW, Kwong YL. Nasal T-cell/natural killer cell lymphoma: CT and MR imaging features of a new clinicopathologic entity. AJR Am J Roentgenol. 2000 Apr. 174(4):1141-5. [QxMD MEDLINE Link].
Sheahan P, Donnelly M, O'Reilly S, Murphy M. T/NK cell non-Hodgkin's lymphoma of the sinonasal tract. J Laryngol Otol. 2001 Dec. 115(12):1032-5. [QxMD MEDLINE Link].
Kim BS, Kim TY, Kim CW, et al. Therapeutic outcome of extranodal NK/T-cell lymphoma initially treated with chemotherapy--result of chemotherapy in NK/T-cell lymphoma. Acta Oncol. 2003. 42(7):779-83. [QxMD MEDLINE Link].
Park S, Ko YH. Epstein-Barr virus-associated T/natural killer-cell lymphoproliferative disorders. J Dermatol. 2014 Jan. 41(1):29-39. [QxMD MEDLINE Link].
Kimura H, Fujiwara S. Overview of EBV-Associated T/NK-Cell Lymphoproliferative Diseases. Front Pediatr. 2018. 6:417. [QxMD MEDLINE Link]. [Full Text].
Sangueza-Acosta M, Sandoval-Romero E. Epstein-Barr virus and skin. An Bras Dermatol. 2018 Nov/Dec. 93 (6):786-99. [QxMD MEDLINE Link]. [Full Text].
Aozasa K, Zaki MA. Epidemiology and pathogenesis of nasal NK/T-cell lymphoma: a mini-review. ScientificWorldJournal. 2011 Feb 14. 11:422-8. [QxMD MEDLINE Link].
Swerdlow E, Campo E, Harris NE, et al. IARC, Lyon. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissue. 4th. 2008.
Pena C, Russo M, Martinez V, Cabrera ME. Extranodal lymphomas in the public health system in Chile: analysis of 1251 patients from the National Adult Cancer Program. Hematol Oncol. 2018 Aug 16. [QxMD MEDLINE Link].
Khariwala SS, Litman DA, McQuone SJ, Hess JL, Thaler ER. Quiz case 2. Natural killer (NK) cell/peripheral T-cell lymphoma. Arch Otolaryngol Head Neck Surg. 2000 Nov. 126(11):1391, 1393. [QxMD MEDLINE Link].
Kommalapati A, Tella SH, Ganti AK, Armitage JO. Natural Killer/T-cell Neoplasms: Analysis of Incidence, Patient Characteristics, and Survival Outcomes in the United States. Clin Lymphoma Myeloma Leuk. 2018 May 4. [QxMD MEDLINE Link].
de Arruda JAA, Schuch LF, Conte Neto N, et al. Oral and oropharyngeal lymphomas: a multi-institutional collaborative study. J Oral Pathol Med. 2021 Jun 6. [QxMD MEDLINE Link].
Suzuki R, Suzumiya J, Yamaguchi M, Nakamura S, Kameoka J, Kojima H, et al. Prognostic factors for mature natural killer (NK) cell neoplasms: aggressive NK cell leukemia and extranodal NK cell lymphoma, nasal type. Ann Oncol. 2010 May. 21(5):1032-40. [QxMD MEDLINE Link].
Su YJ, Wang PN, Chang H, et al. Extranodal NK/T-cell lymphoma, nasal type: clinical features, outcome, and prognostic factors in 101 cases. Eur J Haematol. 2018 Sep. 101 (3):379-88. [QxMD MEDLINE Link]. [Full Text].
Zhang H, Li ZL, Ye SB, et al. Myeloid-derived suppressor cells inhibit T cell proliferation in human extranodal NK/T cell lymphoma: a novel prognostic indicator. Cancer Immunol Immunother. 2015 Oct 23. [QxMD MEDLINE Link]. [Full Text].
Chen Z, Guan P, Shan T, et al. CD30 expression and survival in extranodal NK/T-cell lymphoma: a systematic review and meta-analysis. Oncotarget. 2018 Mar 27. 9 (23):16547-56. [QxMD MEDLINE Link]. [Full Text].
Wang ZY, Liu QF, Wang H, Jin J, Wang WH, Wang SL, et al. Clinical implications of plasma Epstein-Barr virus DNA in early-stage extranodal nasal-type NK/T-cell lymphoma patients receiving primary radiotherapy. Blood. 2012 Jul 23. [QxMD MEDLINE Link].
Liu ZL, Bi XW, Liu PP, Lei DX, Jiang WQ, Xia Y. The Clinical Utility of Circulating Epstein-Barr Virus DNA Concentrations in NK/T-Cell Lymphoma: A Meta-Analysis. Dis Markers. 2018. 2018:1961058. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Vega F, Amador C, Chadburn A, et al. American Registry of Pathology Expert Opinions: Recommendations for the diagnostic workup of mature T cell neoplasms. Ann Diagn Pathol. 2020 Dec. 49:151623. [QxMD MEDLINE Link]. [Full Text].
Paik YS, Liess BD, Scheidt TD, Ingram EA, Zitsch RP 3rd. Extranodal nasal-type natural killer/T-cell lymphoma masquerading as recalcitrant sinusitis. Head Neck. 2009 Apr 9. [QxMD MEDLINE Link].
Chim CS, Ma SY, Au WY, et al. Primary nasal natural killer cell lymphoma: long-term treatment outcome and relationship with the International Prognostic Index. Blood. 2004 Jan 1. 103(1):216-21. [QxMD MEDLINE Link].
Davison SP, Habermann TM, Strickler JG, DeRemee RA, Earle JD, McDonald TJ. Nasal and nasopharyngeal angiocentric T-cell lymphomas. Laryngoscope. 1996 Feb. 106(2 Pt 1):139-43. [QxMD MEDLINE Link].
Jaffe ES. Classification of natural killer (NK) cell and NK-like T-cell malignancies. Blood. 1996 Feb 15. 87(4):1207-10. [QxMD MEDLINE Link].
Rodrigo JP, Suarez C, Rinaldo A, et al. Idiopathic midline destructive disease: fact or fiction. Oral Oncol. 2005 Apr. 41(4):340-8. [QxMD MEDLINE Link].
Cuadra-Garcia I, Proulx GM, Wu CL, et al. Sinonasal lymphoma: a clinicopathologic analysis of 58 cases from the Massachusetts General Hospital. Am J Surg Pathol. 1999 Nov. 23(11):1356-69. [QxMD MEDLINE Link].
Shimizu I, Hamano Y, Sato S, Takeda W, Kirihara T, Sato K, et al. Neurolymphomatosis in a Patient with Extranodal NK/T-cell Lymphoma, Nasal-type: A Case Report and Literature Review. Intern Med. 2014. 53(5):471-5. [QxMD MEDLINE Link].
Luther N, Greenfield JP, Chadburn A, Schwartz TH. Intracranial nasal natural killer/T-cell lymphoma: immunopathologically-confirmed case and review of literature. J Neurooncol. 2005 Nov. 75(2):185-8. [QxMD MEDLINE Link].
Suzuki R. NK/T-Cell Lymphomas: Pathobiology, Prognosis and Treatment Paradigm. Curr Oncol Rep. 2012 Oct. 14(5):395-402. [QxMD MEDLINE Link].
Tse E, Kwong YL. Practical management of natural killer/T-cell lymphoma. Curr Opin Oncol. 2012 Sep. 24(5):480-6. [QxMD MEDLINE Link].
Kwong YL, Kim WS, Lim ST, et al. SMILE for natural killer (NK)/T-cell lymphoma: analysis of safety and efficacy from the Asia Lymphoma Study Group. Blood. 2012 Aug 23. [QxMD MEDLINE Link].
Kim SJ, Yoon SE, Kim WS. Treatment of localized extranodal NK/T cell lymphoma, nasal type: a systematic review. J Hematol Oncol. 2018 Dec 20. 11 (1):140. [QxMD MEDLINE Link]. [Full Text].
Takahara M, Nagato T, Kishibe K, et al. Novel treatment for early-stage nasal natural killer/T-cell lymphoma: intra-maxillary arterial infusion chemotherapy with concomitant radiotherapy. Hematol Oncol. 2015 Nov 13. [QxMD MEDLINE Link].
Lin HN, Liu CY, Pai JT, Chang FP, Yang CF, Yu YB. How to predict the outcome in mature T and NK cell lymphoma by currently used prognostic models?. Blood Cancer J. 2012. 2:e93. [QxMD MEDLINE Link].
Isobe Y, Aritaka N, Setoguchi Y, Ito Y, Kimura H, Hamano Y, et al. T/NK cell type chronic active Epstein-Barr virus disease in adults: an underlying condition for Epstein-Barr virus-associated T/NK-cell lymphoma. J Clin Pathol. 2012 Mar. 65(3):278-82. [QxMD MEDLINE Link].

Media Gallery

Coronal (left) and axial (right) CT scans of the sinus reveal severe pansinusitis with abnormal nasopharyngeal thickening, right facial edema and right temporal bone opacification.
MRI revealed a low, non enhancing T1 signal in the right maxillary, ethmoid and sphenoid sinuses. (left) A high and inhomogeneous T2 signal suggested tumor involvement and destruction of the middle and inferior turbinates. (right)
High-power photomicrograph of a nasopharyngeal mass that was diagnosed as natural killer (NK)–/T-cell lymphoma, nasal type. In this section stained with hematoxylin and eosin, a diffuse infiltrate of variably sized cells with irregularly shaped nuclei that contain coarsely granular chromatin is visible. In other areas of this tumor, necrosis and angiocentrism could be appreciated.
In this photomicrograph, immunohistochemical staining shows neoplastic cells to be positive for the pan T-cell antigen CD3 (positive cells have a brown tinge).
In this photomicrograph, immunohistochemical staining shows neoplastic cells to be positive for the natural killer (NK)–cell antigen CD56 (positive cells have a brown tinge).
In this photomicrograph, immunohistochemical staining shows neoplastic cells to be focally positive for granzyme B (positive cells have a brown tinge).
In this photomicrograph, in situ hybridization for Epstein-Barr virus RNA (EBER) shows positivity in neoplastic cells (positive cells have black nuclei).

of 7

Author

Benjamin Daniel Liess, MD Assistant Professor, Department of Otolaryngology, University of Missouri-Columbia School of Medicine

Benjamin Daniel Liess, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, The Triological Society, American Medical Association, Missouri State Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Jerry W Templer, MD Professor, Department of Otolaryngology, University of Missouri-Columbia School of Medicine

Jerry W Templer, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, Missouri State Medical Association, Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; Ryte; Neosoma; MI10<br/>Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX)<br/>Received ownership interest from Cerescan for consulting for: Neosoma, MI10.

Acknowledgements

Benoit J Gosselin, MD, FRCSC Associate Professor of Surgery, Dartmouth Medical School; Director, Comprehensive Head and Neck Oncology Program, Norris Cotton Cancer Center; Staff Otolaryngologist, Division of Otolaryngology-Head and Neck Surgery, Dartmouth-Hitchcock Medical Center

Benoit J Gosselin, MD, FRCSC is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, American Medical Association, American Rhinologic Society, Canadian Medical Association, Canadian Society of Otolaryngology-Head & Neck Surgery, College of Physicians and Surgeons of Ontario, New Hampshire Medical Society,North American Skull Base Society, and Ontario Medical Association

Disclosure: Nothing to disclose.

M Sherif Said, MD, PhD Associate Professor of Pathology, Director of Head and Neck Pathology, Department of Pathology, University of Colorado School of Medicine

M Sherif Said, MD, PhD is a member of the following medical societies: American Society for Clinical Pathology and College of American Pathologists

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Acknowledgments

The authors would like to acknowledge Young S Paik, MD, for his assistance in the preparation and review of this manuscript.