Evaluating the effectiveness of immunochemotherapy treatments for advanced stage follicular lymphoma.

This study compared the effectiveness of common immuno-chemotherapy (ICT) treatments for advanced follicular lymphoma (FL) for front-line therapy. The study showed that obinutuzumab (Gazyva; G) combined with bendamustine (Treanda; Benda) (G-Benda-G regimen) had the best survival without cancer worsening in patients with advanced FL. 

FL is a type of non-Hodgkin lymphoma (NHL), a category of cancers that affects the lymphatic system (the part of the immune system that contains a watery, protective fluid called lymph). FL causes uncontrolled growth and multiplication of B-cells.

Currently, there is no single, established standard-of-care frontline therapy for advanced FL. However, different options exist such as bendamustine (Benda), CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone), CVP (cyclophosphamide, vincristine, and prednisone) combined with rituximab (Rituxan; R), or obinutuzumab (G), in addition to lenalidomide (Revlimid; Len). It is important to compare the effectiveness of these existing therapies in patients with advanced FL. 

This analysis included a total of 7 studies evaluating ICT treatment options for patients with advanced FL. 11 modern ICT and maintenance therapy options were included such as R-CVP, R-CHOP, R-Benda, R-CVP-R, R-CHOP-R, B-Benda-R, R-Benda-R4, G-CVP-G, G-CHOP-G, G-Benda-G, and R-Len-R. R-Benda-R4 involved R-Benda followed by 4 years of rituximab maintenance therapy. For the other treatment options, rituximab or obinutuzumab maintenance therapy was administered for 2 years. Survival without cancer worsening was compared among treatment options.

Compared to R-Benda, G-Benda-G had a better survival without cancer worsening and was 72% likely of being the best treatment. This was followed by R-Benda-R4 and R-Benda-R. A similar level of effectiveness was seen for R-CHOP-R, R-Len-R, and R-Benda.

Bendamustine was better than CHOP with or without maintenance therapy. Maintenance with rituximab improved survival without cancer worsening after R-CHOP or R-Benda.

The study found that G-Benda-G, followed by R-Benda-R4 and R-Benda-R, had the highest effectiveness regarding survival without cancer worsening in patients with advanced FL.

The study did not directly compare the effectiveness of therapies and lacked data on overall survival and side effects. The number of trials included was small and only three Phase 3 studies were analyzed. Further clinical trials are needed.