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Shorter RCHOP regimen as effective, cuts adverse events
Poeschel V. et al. ASH 2018 Abstract 781
Key clinical point: A shortened regimen of four cycles of rituximab (R) plus cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy was noninferior in efficacy to the standard six cycles of R-CHOP in younger patients with favorable-risk diffuse large B-cell lymphoma (DLBCL) in the FLYER trial (NCT00278421).
Major finding: Progression-free survival (PFS), event-free survival (EFS), and overall survival (OS) were comparable in patients who received four cycles and six cycles of R-CHOP. At a median follow-up of 66 months, the PFS rate, the primary endpoint, was 94% in the six-cycle group and 96% for the four-cycle group. Similarly, the rate of 3-year OS was 98% in the six-cycle group, compared with 99% in the four-cycle group, and the survival curves were virtually superimposable out to more than 10 years of follow-up. Six cycles of R-CHOP led to a higher toxicity with respect to leukocytopenia and anemia, both of any grade and also of grades 3 to 4.
Data source: 172 patients assigned to six cycles and 107 assigned to four cycles in a study by the German High-Grade Non-Hodgkin’s Lymphoma Study Group/German Lymphoma Alliance
Disclosures: The study was supported by Deutsche Krebshilfe. Dr. Poeschel disclosed travel grants from Roche and Amgen. Dr. Steensma had no disclosures relevant to the study.
Source: Poeschel V. et al. ASH 2018 Abstract 781.
Poeschel V. et al. ASH 2018 Abstract 781.
Dr. David Henry, Editor in Chief of MDedge Hematology/Oncology, comments:
RCHOP continues to be a very effective regimen in diffuse large B-cell lymphoma (DLBCL) patients. While the original regimen is RCHOP for six cycles, some patients may have a shorter course such as RCHOP x 3 with involved-field radiation therapy for those with very localized disease.
The current FLYER trial examined patients younger than 60 years old with favorable prognosis DLBCL defined as those with an age-adjusted international prognostic index (IPI) score of zero and a tumor mass of 7.5 cm or less. Four cycles RCHOP was compared to six cycles in 588 evaluable patients on a one to one basis. The results revealed no differences in progression free, event free, or overall survival between the two arms at a median followup of 66 months. In particular, the three-year overall survival was 98% in the six-cycle group and 99% in the four-cycle group.
While the authors emphasize these results are only applicable to the population studied, patients less than 60 years old and with age-adjusted IPI score of zero, nevertheless, this results suggest these patients can do just as well with only four cycles of RCHOP, exposing them to less drug and less potential for adverse events. So, perhaps a practice changing approach, but we will continue to watch as study results mature.