Peripheral T-cell lymphomas (PTCL) are uniquely vulnerable to epigenetic modifiers. We demonstrated in vitro synergism between histone deacetylase inhibitors and DNA methyltransferase inhibitors in preclinical models of T-cell lymphoma. In a phase 1 trial we found oral 5-azacytidine (AZA) and romidepsin (ROMI) to be safe and effective, with lineage-selective activity among patients with relapsed/refractory (R/R) PTCL. Patients with treatment-naïve (TN) or R/R PTCL received AZA 300 mg daily, days 1-14 and ROMI 14 mg/m2, days 8, 15, and 22, every 35 days. The primary objective was overall response rate (ORR). Targeted next-generation sequencing was performed on tumor samples to correlate mutational profiles and response. Among 25 enrolled patients the ORR and complete response rates were 61% and 48%, respectively. However, patients with T-follicular helper cell (tTFH) phenotype exhibited higher ORR (80%) and complete remission rate (67%). The most frequent grade 3-4 adverse events were thrombocytopenia (48%), neutropenia (40%), lymphopenia (32%) and anemia (16%). At a median follow-up of 13.5 months the median PFS, DOR, and OS were 8.0 months, 20.3 months, and not reached, respectively. The median PFS and OS were 8.0 months and 20.6 months, respectively, in patients with R/R disease. Patients with tTFH enjoyed a particularly long median survival (median not reached). Responders harbored a higher average number of mutations in genes involved in DNA methylation and histone deacetylation. Combined AZA and ROMI are highly active in PTCL patients and could serve as a platform for novel regimens in this disease. The trial was registered at www.clinicaltrials.gov, #NCT01998035

Goals: Assess the impact of a web-based multimedia patient engagement program on patient anxiety, perception and knowledge about the colonoscopy in addition to procedure outcomes. Background: The success of patients coming for a colonoscopy for colorectal cancer screening is dependent in part on patients’ understanding of the preparation and of the procedure. Patients were randomized to use either our institution’s standard preprocedure colonoscopy packet or a web-based multimedia patient engagement program (Emmi Solutions) before their scheduled procedure. On the day of colonoscopy, all participants completed a survey including questions to assess knowledge and perception of colonoscopy, in addition to the State Trait Anxiety Inventory. We also collected procedure data including medication doses and procedure time. Study Results: Patients in the experimental group correctly answered knowledge questions (82%) more often than the control group (74%) (P=0.0003). More than half (58%) of patients in the experimental group felt this intervention reduced their anxiety about the procedure, and the State Trait Anxiety Inventory anxiety score was lower in the experimental group (P=0.026). Patients who viewed the program required less midazolam (3.66 vs. 4.46 mg, P=0.0035) and total procedure time was shorter (24.8 vs. 29 min, P=0.024). Conclusions: A web-based multimedia patient engagement program watched before colonoscopy decreased patient anxiety, medication requirements, and procedure time while increasing knowledge. This intervention could help patients understand and feel more comfortable about colonoscopy leading to increased screening rates while increasing efficiency and decreasing recovery time.