Rituximab Added To Six Cycles Of Chemotherapy Improves Survival In Elderly Patients With Aggressive Lymphoma

Main Category: Lymphoma / Leukemia / Myeloma
Also Included In: Seniors / Aging;  Cancer / Oncology
Article Date: 21 Jan 2008 - 3:00 PDT

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In elderly patients with diffuse large B-cell lymphoma (DLBCL),* six cycles of CHOP-14 chemotherapy** in combination with eight applications of rituximab (R-CHOP-14) is as efficacious as eight cycles of R-CHOP-14 and should be the preferred treatment for elderly patients, according to authors reporting in an Article to be published early Online and in the February issue of The Lancet Oncology. Importantly for this elderly population, patients can be spared the toxicity and side-effects of an additional two cycles of chemotherapy, the authors note.

For more than 25 years, the CHOP regimen was the standard care for aggressive lymphomas. However, in 2000, The French Groupe de L'Etude des Lymphomes de L'Adulte showed that the addition of the monoclonal anti-CD20 antibody, rituximab, to eight cycles of 3-weekly CHOP (CHOP-21) chemotherapy improved outcome for patients with DLBCL. A similar improvement was shown by the German High-Grade Non-Hodgkin Lymphoma Study Group (DSHNHL) by decreasing the chemotherapy interval for six cycles of CHOP chemotherapy from 3 to 2 weeks (CHOP-14). Both approaches improved the outcome of elderly patients without increasing side-effects. However, the most effective treatment regimen, in terms of duration and number of cycles, is still unclear.

Therefore, Professor Michael Pfreundschuh (Saarland University Medical School, Homburg, Germany) and colleagues from the German DSHNHL group recruited 1222 patients (aged 60-80 years) with DLBCL from 203 institutions in Germany, the Czech Republic, and Switzerland between 2000 and 2005. Patients were randomly assigned to receive six or eight cycles of CHOP-14, with or without rituximab.

The researchers noted that 3-year event-free survival was 47.2% after six cycles of CHOP- 14, 53.0% after eight cycles of CHOP-14, 66.5% after six cycles of R-CHOP-14, and 63.1% after eight cycles of R-CHOP-14. Furthermore, 3-year overall survival was 67.7% for six cycles of CHOP-14, 66.0% for eight cycles of CHOP-14, 78.1% for six cycles of R-CHOP-14, and 72.5% for eight cycles of R-CHOP-14.

The authors say: "Six cycles of R-CHOP-14 significantly improved event-free, progressionfree, and overall survival over six cycles of CHOP-14 treatment. Response-adapted addition of chemotherapy beyond six cycles, though widely practiced, is not justified. Of the four regimens assessed in this study, six cycles of R-CHOP-14 is the preferred treatment for elderly patients, with which other approaches should be compared."

Note

* Diffuse large B-cell, CD20+ (DLBCL) is a type of non-Hodgkin's lymphoma (NHL). DLBCL is an aggressive lymphoma that occurs in about 3 of 10 cases of NHL. Cells are large, and the cancer often grows quickly. More than half the patients with DLBCL are over 60 years of age.

** CHOP-14 chemotherapy-cyclophosphamide, doxorubicin, vincristine, and prednisolone at 2-weekly intervals.

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