Yazarlar : Presented at ASCO

Yayın : DGNews

Yayın Yılı : 2014

Pubmed Linki : http://www.docguide.com/adding-lenalidomide-r-chop-regimen-may-benefit-patients-b-cell-lymphoma-phenotype?tsid=5

Konu : Diğer

Literatür İçeriği :  By Walter Alexander

CHICAGO -- June 3, 2014 -- Adding lenalidomide to the standard drug regimen used to treat patients with diffuse large B-cell lymphoma (DLBCL) may lead to significant improvements in progression-free survival and overall survival, at least for patients with a specific phenotype of the disease, according to phase 2 study results presented at the 2014 Annual Meeting of the American Society of Clinical Oncology (ASCO).

There are 2 distinct biological and molecular sub-types of DLBCL: germinal center B-cell (GCB) lymphoma and activated B-Cell lymphoma, which is also known as non-GCB lymphoma, explained Grzegorz Nowakowski MD, Mayo Clinic, Rochester, Minnesota, speaking at an oral presentation here on May 31.

Standard therapy known as R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, prednisone) is used to treat both phenotypes of DLBCL, although patients with the non-GCB subtype experience significantly worse progression-free survival and overall survival compared with patients with the GCB phenotype.

In a previous study among patients who had relapsed when treated with R-CHOP and were then given lenalidomide, 30% of patients had a positive response that lasted a mean of 4 months, Dr. Nowakowski noted. This response was greatest among patients with the non-GCB phenotype. For this reason, Dr. Nowakowski and colleagues hypothesised that adding lenalidomide to the R-CHOP regimen (known as R2CHOP) could benefit patients with non-GCB B-cell lymphoma.

In the current study which Dr. Nowakowski presented here, 64 patients were treated with a standard regimen of R-CHOP on a 21-day cycle. Lenalidomide 25 mg was given on days 1 to 10, pegfilgrastim 6 mg was given on day 2, and aspirin 325 mg was given daily.

All patients had newly diagnosed stage II to IV DLBCL with measureable disease, and 0 to 2 performance status. Sixty percent had stage IV disease, which indicated that they were a “relatively high-risk group,” Dr. Nowakowski said. Mean age was 65 years, although 25% were greater than 75 years of age and 10% were greater than 85 years of age.

Among 60 evaluable patients, 18% showed a partial response while 80% had a complete response. Progression-free survival and overall survival rates were “encouraging” Dr. Nowakowski said: 59% and 78%, respectively, at 2 years follow-up.

The results from this relatively small trial were also compared with a cohort of 87 historical controls who had been treated with R-CHOP alone. Overall outcomes were comparable between the 2 treatment modalities. When patients were separated according to their disease phenotype, however, there were significant differences in both progression-free survival and overall survival between the 2 phenotypes when patients were treated with R-CHOP. Patients with non-GCB fared significantly worse compared with those with the GCB phenotype. Among patients treated with R2CHOP, however, there were no differences in progression-free survival or overall survival between the 2 subgroups.

Dr. Nowakowski commented further that lenalidomide used in combination with R-CHOP was well tolerated, even among elderly patients with advanced disease. The addition of lenalidomide seemed to ameliorate the negative impact of R-CHOP on patients with the non-GCB phenotype of B-cell lymphoma.

An ongoing randomised trial will determine whether this benefit for patients with the non-GCB phenotype will persist in a larger cohort of B-cell lymphoma patients.

[Presentation title: Effect of Lenalidomide Combined With R-CHOP (R2CHOP) on Negative Prognostic Impact of Nongerminal Center (Non-GCB) Phenotype in Newly Diagnosed Diffuse Large B-Cell Lymphoma: A Phase 2 Study. Abstract 8520]

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