For a patient with ENKTL nasal type (nose/sinus involvement) who has hepatic toxicity with pegasparaginase but a CR after 2 cycles of chemotherapy with a plan for "sandwich" radiotherapy - what, if any, chemotherapy would you resume after completion of radiation?

This is an interesting situation as there is not much data. The cure rate is high for early-stage disease after chemoradiation, even with VIPD and no asparaginase regimens (see de Pádua Covas Lage et al., PMID 36446856). Nature reviews which show in Table 2 survival curves similar for asparaginase r...

ENKTCL are often intrinsically resistant to anthracycline-based therapies due to high level expression of the multidrug resistant P-glycoprotein resulting in efflux of certain drugs from cancer cells, which underpins the importance of asparaginase in the management of this disease.

However, there is ...