The study is to compare the efficacy of romidepsin when administered with CHOP versus CHOP alone in subjects with previously untreated peripheral T-cell lymphoma (PTCL) in terms of progression-free survival (PFS) using assessment of progressive disease according to malignant lymphoma criteria (1999) by Response Adjudication Committee (RAC).

Treatment

#CHOP
CYCLOPHOSPHAMIDE IV	750mg/m²	D1
DOXORUBICIN	IV	50mg/m²	D1
VINCRISTINE	IV	1.4mg/m² (max 2 mg)	D1
PREDNISONE	PO	40mg	 D1-5
----> every 3weeks (Max 6cycls)

#Ro-CHOP
CYCLOPHOSPHAMIDE IV	750mg/m²	D1
DOXORUBICIN	IV	50mg/m²	D1
VINCRISTINE	IV	1.4mg/m² (max 2 mg)	D1
PREDNISONE	PO	40mg	 D1-5
ROMIDEPSIN IV 12mg/m² (IV over 4 hrs) D1 & 8
----> every 3weeks (Max 6cycls)

Romidepsin has shown broad antitumor activity in vivo in multiple human tumor types, including both solid and hematologically-derived tumors.

Arm Label

Target Number of Participant

Arm Type

Arm Description

CYCLOPHOSPHAMIDE IV	750mg/m²	D1
DOXORUBICIN	IV	50mg/m²	D1
VINCRISTINE	IV	1.4mg/m² (max 2 mg)	D1
PREDNISONE	PO	40mg	 D1-5
----> every 3weeks (Max 6cycls)

Arm Label

Target Number of Participant

Arm Type

Arm Description

CYCLOPHOSPHAMIDE IV	750mg/m²	D1
DOXORUBICIN	IV	50mg/m²	D1
VINCRISTINE	IV	1.4mg/m² (max 2 mg)	D1
PREDNISONE	PO	40mg	 D1-5
ROMIDEPSIN IV 12mg/m² (IV over 4 hrs) D1 & 8
----> every 3weeks (Max 6cycls)

Gender

Age

Description

1. Males and females of 18 years of age to 80 years of age.
2. Understand and voluntarily sign an informed consent document prior to any study related assessments/procedures are conducted.
3. Able to adhere to the study visit schedule and other protocol requirements.
4. Patients with histologically proven peripheral T-cell lymphoma (PTCL), not previously treated; the following subtypes as defined by the WHO classification (2008;2011) may be included, whatever the Ann Arbor stage (I - IV):
a. Nodal types:
i. PTCL, not otherwise specified
ii. Angioimmunoblastic T-cell lymphoma
iii. Anaplastic large cell lymphoma, ALK-negative type
b. Extra-nodal types:
i. Enteropathy-associated T-cell lymphoma
ii. Hepato-splenic T-cell lymphoma
iii. Subcutaneous panniculitis-like T-cell lymphoma
iv. Primary cutaneous gamma-delta T-cell lymphoma
v. Primary cutaneous CD8+ aggressive epidermotropic lymphoma
vi. Primary cutaneous CD4+ small/medium T-cell lymphoma
c. Other non classifiable peripheral T-cell lymphoma
5. ECOG performance status 0, 1 or 2
6. Negative pregnancy test for females of childbearing potential (FCBP)
7. Female patients of child bearing potential must use an effective method of birth control (i.e. hormonal contraceptive, intrauterine device, diaphragm with spermicide, condom with spermicide or abstinence) during treatment period and 1 month thereafter; Males must use an effective method of birth control during treatment period and 3 months thereafter.
8. Life expectancy of ≥ 90 days (3 months).

1. Any significant medical condition, laboratory abnormality, or psychiatric illness that would prevent the patient from participating in the study.
2. Any condition that confounds the ability to interpret data from the study.
3. Other types of lymphomas, e.g. B-cell lymphoma
4. The following types of T cell lymphomas:
a. Adult T-cell lymphoma/leukemia (HTLV-1 related T-cell lymphoma)
b. Extranodal T-cell/NK-cell lymphoma, nasal type
c. Anaplastic large cell lymphoma, ALK-positive type
d. Cutaneous T cell lymphoma (mycosis fungoides, Sézary syndrome)
e. Primary cutaneous CD30+ T-cell lymphoproliferative disorder
f. Primary cutaneous anaplastic T-cell lymphoma
5. Previous treatment for PTCL with immunotherapy or chemotherapy except for short-term corticosteroids (duration of ≤ 8 days) before randomization
6. Previous radiotherapy for PTCL except if localized to one lymph node area
7. Patients planned for autologous or allogeneic transplant as consolidation in first line
8. Central nervous system -meningeal involvement
9. Contraindication to any drug contained in the chemotherapy regimen,
10. Subjects with HIV positivity
11. Subjects with active hepatitis B or C. Chronic carriers of hepatitis B without HBV DNA positive blood are eligible after advice from hepatologist and initiation of prophylactic treatment if needed. Subjects with non-active hepatitis C (with normal transaminases) are eligible. Patients with HBc Ab+/ HBs Ab+/ HBs Ag- and HBV DNA- should be referred to an hepatologist and a prophylactic treatment should be initiated if needed
12. Any of the following laboratory abnormalities, except if secondary to the
lymphoma:
a. Absolute neutrophil count (ANC) < 1,500 cells/mm3 (1.5 x 109/L),
b. Platelet count < 100,000/mm3 (100 x 109/L), or < 75,000/mm3 if bone marrow is involved,
c. Serum SGOT/AST or SGPT/ALT ≥ 3.0 x upper limit of normal (ULN),
d. Serum total bilirubin > 2 x ULN, except in case of hemolytic anemia,
e. K+ and Mg2+ levels < LLN, except if corrected per protocol guidance before beginning the romidepsin infusion
13. Serum creatinine > 2.0 x ULN
14. Prior history of malignancies other than lymphoma (except for basal cell or squamous cell carcinoma of the skin or carcinoma in situ of the cervix or breast or untreated prostatic cancer without any plan for a treatment) unless the patient has been free of the disease for ≥ 3 years
15. Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the patient from signing the informed consent form 
16. Any known cardiac abnormalities such as:
a. Patients with congenital long QT syndrome
b. Corrected QT interval > 480 msec (using the Fridericia formula)
c. Myocardial infarction within 6 months of cycle 1 day 1
d. History of or concomitant significant cardiovascular disease
e. Ejection fraction <45% by MUGA scan or by echocardiogram;
17. Concomitant use of drugs that may cause a significant prolongation of the QTc
18. Patients who have received more than 200 mg/m2 doxorubicin
19. Concomitant use of strong CYP3A4 inhibitors
20. Concomitant use of therapeutic warfarin due to a potential drug interaction. Use of a low dose of warfarin or another anticoagulant to maintain patency of venous access port and cannulas is permitted.
21. Clinically significant active infection
22. Use of any standard or experimental anti-cancer drug therapy within 28 days of the initiation (Day 1) of study drug
23. Pregnant or lactating females or women of childbearing potential not willing to use an adequate method of birth control for the duration of the study.

Progression-free survival

Progression-free survival is defined as the time from randomization into the study to the first observation of documented disease progression or death due to any cause.

Overall survival

Overall survival will be measured from the date of randomization to death for any reason.

Overall response rate

From the time of acquisition of the complete response or partial response for any reason, the disease progression, recurrence or death will be measured by the date of the first confirmation.