In a nutshell
This study compared different chemotherapy regimens and rituximab (Rituxan) for the initial treatment of advanced follicular lymphoma. This study concluded that the combinations R-CHOP and R-FM were more effective than R-CVP. R-CHOP was associated with fewer severe side effects than R-FM.
Some background
Follicular lymphoma (FL) is the most common form of indolent non-Hodgkin lymphoma. Most patients have advanced disease when diagnosed. Systemic therapy, such as chemotherapy, is needed in these patients. Patients with FL are also at high risk of disease relapse.
The addition of rituximab to chemotherapy has improved outcomes. Rituximab is a monoclonal antibody that blocks the activity of a protein present on many cancer cells. This leads to cancer cell death. The most effective chemotherapy combination to use with rituximab is not yet clear.
Methods & findings
The current study compared the outcomes of three different chemotherapy combinations plus rituximab. 504 patients were randomly assigned to one of three treatment groups. Patients in the R-FM group were treated with rituximab plus the chemotherapies fludarabine and mitoxantrone. Patients in the R-CVP group were treated with rituximab plus cyclophosphamide, vincristine, and prednisone. Patients in the R-CHOP group were treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone. Patients were followed for an average of 34 months.
The 3-year time to treatment failure (time from treatment until disease relapse or non-response to treatment) rate was significantly better in the R-CHOP (62%) and R-FM (59%) groups compared to the R-CVP group (46%). 3-year progression-free survival (time from treatment until disease progression) was also significantly higher in the R-CHOP (68%) and R-FM (63%) groups compared to R-CVP (52%). Three-year overall survival (time from treatment until death from any cause) for all groups together was 95%.
Patients in the R-FM group were more likely to have seriously low levels of white blood cells (64%) compared to the R-CHOP (50%) and R-CVP (28%) groups. Seriously low levels of platelets (blood cells involved in clotting) also occurred more often in the R-FM group (8%) compared to R-CHOP (3%) or R-CVP (0%).
The bottom line
This study concluded that R-FM and R-CHOP were more effective than R-CVP. Patients treated with R-FM had higher rates of side effects.
Published By :
Journal of clinical oncology
Date :
Apr 20, 2013
