In a nutshell
This study evaluated the effectiveness and safety of first-line (primary) treatment with VR-CAP (bortezomib, rituximab, cyclophosphamide, doxorubicin, prednisone) versus R-CHOP (VR-CAP with vincristine instead of bortezomib) alone in previously untreated patients with mantle cell lymphoma (MCL). This study concluded that VR-CAP was well-tolerated and associated with significantly longer survival compared to R-CHOP in these patients.
Chemoimmunotherapy is the typical first-line treatment for patients with MCL. For elderly patients who are not good candidates for a stem cell transplant, R-CHOP chemotherapy remains the standard first-line treatment. However, many patients eventually experience relapse (cancer recurrence). These patients need alternative treatment options.
Bortezomib (Velcade) has been used as a single treatment (monotherapy) for patients with MCL. This agent blocks cancer cell growth and survival. The long-term benefits of bortezomib-based therapy in transplant-ineligible patients with MCL compared to R-CHOP remain under investigation.
Methods & findings
This study involved 268 patients with previously untreated MCL. 140 patients received VR-CAP and 128 received R-CHOP. Patients were followed-up for an average of 82 months.
The average overall survival (OS; time from treatment until death from any cause) was significantly longer for the VR-CAP group than the R-CHOP group (90.7 months vs. 55.7 months). VR-CAP was significantly associated with a 34% lower risk of death. Four-year OS rate was longer in the VR-CAP group than the R-CHOP group (67.3% vs. 54.3%). Six-year OS was also longer in the VR-CAP group (56.6% vs. 42.0%).
More patients in the VR-CAP group stopped treatment due to side effects compared to the R-CHOP group (8% vs. 6%). 2% of patients in both groups reported infections. Other side effects included nervous system disorders (2% vs. 1%) and heart problems (1% in both).
After initial treatment, fewer patients in the VR-CAP group underwent additional therapy compared to the R-CHOP group (43% vs. 62%).
The bottom line
This study concluded that VR-CAP was well-tolerated and associated with significantly longer survival compared to R-CHOP in patients with previously untreated MCL.
Published By :
The Lancet. Oncology
Oct 18, 2018
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