Researcher discusses alternatives to R-CHOP for DLBCL patient subset

Patients with the most common subtype of lymphoma, diffuse large B-cell lymphoma, generally undergo the standard of care, which is combination chemotherapy known as R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone). This regimen has proven to be successful and generally cures between one half and two-thirds of all DLBCL patients. The rest of those patients face a much worse prognosis and require alternative treatments.

Earlier this year at the 16th Annual International Congress on Hematologic Malignancies, John Leonard MD of Weill Cornell Medical College in New York City discussed some of these alternative treatments, a discussion that has been published by OncLive.

R-ACVBP
Dose-intensive rituximab plus doxorubicin, cyclophosphamide, vindesine, bleomycin and prednisone.

In a Phase III study, R-ACVBP produced better progression-free survival and overall survival rates than R-CHOP in patients under the age of 60. Unfortunately, the regimen causes severe hematologic toxicities, leading in some cases to toxic death. This has understandably prevented this regimen from catching on.

R-EPOCH
Rituximab plus etoposide, prednisone, vincristine, doxorubicin and cyclophosphamide.

A Phase II trial showed that R-EPOCH's PFS can be as high as 79%. It is currently under investigation in a Phase III trial, known as CALGB 50303, which is pitting R-EPOCH against R-CHOP in patients with newly diagnosed DLBCL.

R-CHOP plus ...
Several studies are underway seeking to add another drug to the R-CHOP regimen, even though many people are hesitant to fix what clearly isn't broken. Agents that are under consideration include epratuzumab, bortezomib, lenalidomide, and enzastaurin.

Says Dr. Leonard, “Ultimately what we will be seeing is novel agents that target molecular subtypes of large cell lymphoma that are defined in more modern ways. The message here is that for this [high-risk] group of patients, we really need to continue to look and place a high priority on assessing some of these novel approaches.”

Source: OncLive