FDA APPROVED THE GENERIC DOXIL IN REPONSE TO SHORTAGE AND ITS CONSEQUENCES ON ONCOLOGY PRACTICES ACROSS THE UNITED STATES.
The Generic version is manufactured by SUN PHARMA GLOBAL FZE.
Shortage was first believed to be a commercial ploy to increase the price until it became real.   This approval will limit chances of new shortage and will help patients with Myeloma, Kaposi sarcoma and Ovarian Cancers who need this medication the most.

UPDATE ON TREATMENTS OF PERIPHERAL T CELL LYMPHOMA

3 AGGRESSIVE TYPES:
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1. PTLC- NOS
2. AITL: AngioImmunoblastic
3ALCL (Anaplastic large cell  (ALK +)  6% AND     alk NEGATIVE
CD30 , t(2,5)(p23,q25)
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1 Peripheral T cell lymphoma not otherwise specified
-PET
-Gene Profiling
treat it with EPOCH (CHOEP) or Etoposide based regimen followed by transplant
consider Romidepsin (upfront in Europe)
followed by Gemcitabine, Navelbine (Doxil)

Europeans give ACVBP +/- Romidepsin (Vindesin not available in the US)

refractory disease" FDA has released 3 drugs, their role and position is being evaluated"
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Romidepsin
Pralatrexate
CD30 positive - BRENTUXIMAB VEDOITIN
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2. some T cell lymphoma are clearly Indolent i.e Mycosis Fungoides (MF)
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3. Anaplastic Large cell Lymphoma
ALK negative
for Europeans ACVBP followed by transplant

USA, same paradigm as in PTCL NOS

FOR ALK POSITIVE -- CHOP  ALONE IS THE BEST NO TRANSPLANT (NO ETOPOSIDE NEEDED)   (THE GERMAN STUDY WAS RETROSPECTIVE )
CRIZOTINIB

PRALATREXATE AND ROMIDEPSIN HAVE BEEN USED IN CLINICAL TRIAL
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4. ANGIOIMMUNOBLASTIC

STEROIDS
SOME CLAIM CYCLOSPORINE (PARTICULARLY WHEN HEMOLYTIC ANEMIA)

IN EUROPE CHOP-ROMIDEPSIN

IN USA, GEMZAR
FOR THOSE WITH A COMPONENT OF CD20 POSITIVE, RITUXAN +STEROID

WHATEVER YOU DO, DON'T GIVE ADRIAMYCIN!