VR-CAP vs R-CHOP chemotherapy for patients with mantle cell lymphoma

This study looked at the difference in outcomes for patients with mantle cell lymphoma who were treated with either VR-CAP or R-CHOP chemotherapy regimens. The authors concluded that patients treated with VR-CAP had significantly better outcomes than patients who were treated with R-CHOP.

Mantle cell lymphoma (MCL) is an uncommon but aggressive form of non-Hodgkin lymphoma. It is considered incurable. The standard therapy for patients is R-CHOP chemotherapy (rituximab, plus cyclophosphamide, doxorubicin, vincristine, and prednisone). One study found that approximately half of patients treated with R-CHOP achieved a complete response (no detectable cancer). However, the average time from treatment to disease progression was only 16.6 months.

VR-CAP (rituximab, plus cyclophosphamide, doxorubicin, bortezomib, and prednisone) has been approved as a substitute for R-CHOP. More research is needed that directly compares the two treatments. 

487 patients participated in this study. 243 were randomized to receive the new treatment, VR-CAP. 244 were randomized to receive the standard treatment, R-CHOP.

The average progression free survival (time from treatment to disease progression) for patients treated with VR-CAP was 24.7 months. The average progression free survival time for patients treated with R-CHOP was 14.4 months. The difference was highly significant.

The average progression free survival length for patients who achieved a complete response was significantly longer for patients treated with VR-CAP (40.9 months) than patients treated with R-CHOP (19.8 months).

The same trend was true for patients who only achieved partial response (a decrease in tumor size, but cancer still present). Patients treated with VR-CAP had an average progression free survival of 17.1 months. Patients treated with R-CHOP had an average progression free survival of 11.7 months.

Patients who were assessed as being low or intermediate risk had even better responses to VR-CAP compared to R-CHOP. The difference between the two treatments was not as large for patients with high risk disease. 

The study concluded that patients treated with VR-CAP have significantly better outcomes, especially those with low- or intermediate-risk disease or who achieved a complete response.