In a nutshell
This study evaluated the effectiveness and safety of a new chemotherapy regimen for patients with non-Hodgkin’s lymphoma (NHL). This study concluded that this regimen was highly effective for these patients, but was associated with some side effects.
For patients with NHL, age is one determining factor for treatment approach. Patients younger than age 60 may respond well to aggressive treatment. However, older patients can have poorer outcomes or decline aggressive treatment altogether. Whether less intense therapy is less effective than more aggressive treatment is unclear. Identifying treatments that are effective for patients with NHL regardless of age remains challenging.
R-cladribine (rituximab, cladribine) is a regimen that has shown promise in recent studies. Adding new anti-cancer agents to this regimen may help improve patient outcomes. One such agent is vorinostat (Zolinza). Vorinostat interferes with important proteins called histone deacetylases. Blocking the activity of these proteins leads to cancer cell death. Whether this combined regimen is safe and effective for patients with NHL is under investigation.
Methods & findings
This study had 67 patients with NHL. More than half (39 patients) had mantle cell lymphoma (MCL). All patients received SCR chemotherapy (vorinostat, cladribine, rituximab). Patients were followed-up for an average of 42 months.
This study had two phases. Phase 1 evaluated the most effective dose of vorinostat. This part of the study had 10 patients with NHL that came back after initial treatment (relapsed). Phase 2 evaluated how well patients responded to treatment. This part of the study had 57 patients. Most of these patients (39) were not treated before. 10 patients had recurrent cancer.
In phase 1, 40% of patients responded to treatment. Most patients reported serious side effects. The most common ones were low white blood cell count (80%), low platelet count (cells involved in blood clotting; 60%), and low red blood cell count (50%). Infections and fatigue were also reported (both 30%).
In phase 2, 97% of previously untreated patients responded to treatment. 80% of patients had a complete disappearance of all signs of cancer. 39% of patients who had relapsed disease responded to treatment. As in phase 1, the most common serious side effects were low white blood cell count (67%) and low platelet count (42%). Only 11% of patients developed serious infections.
Overall, 87% of patients in phase 2 were still alive 2 years later. 5 years later, this rate was 76.8%. Patients who were not treated before survived for an average of 84 months without tumor growth or spread. 61.5% of these patients were still alive 4 years later without tumor growth or spread. This rate was 20.8% for patients who had recurrent cancer.
The bottom line
This study concluded that the SCR regimen was highly effective for patients with NHL, especially patients with MCL. The authors suggest that adding other anti-cancer drugs to this regimen warrants further investigation.
The fine print
This was a very small study. Larger studies are needed to confirm these results.
Published By :
British Journal of Haematology
Jun 09, 2019
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