McMillan, AK;
Phillips, EH;
Kirkwood, AA;
Barrans, S;
Burton, C;
Rule, S;
Patmore, R;
Pettengell, R;
Ardeshna, KM;
Lawrie, A;
et al.
McMillan, AK; Phillips, EH; Kirkwood, AA; Barrans, S; Burton, C; Rule, S; Patmore, R; Pettengell, R; Ardeshna, KM; Lawrie, A; Montoto, S; Paneesha, S; Clifton-Hadley, L; Linch, DC
(2020)
Favourable outcomes for high-risk diffuse large B-cell lymphoma (IPI 3-5) treated with front-line R-CODOX-M/R-IVAC chemotherapy: results of a phase 2 UK NCRI trial.
Ann Oncol, 31 (9).
pp. 1251-1259.
ISSN 1569-8041
https://doi.org/10.1016/j.annonc.2020.05.016
SGUL Authors: Pettengell, Ruth
Abstract
BACKGROUND: Outcomes for patients with high-risk diffuse large B-cell lymphoma (DLBCL) treated with R-CHOP chemotherapy are suboptimal but, to date, no alternative regimen has been shown to improve survival rates. This phase 2 trial aimed to assess the efficacy of a Burkitt-like approach for high-risk DLBCL using the dose-intense R-CODOX-M/R-IVAC regimen. PATIENTS AND METHODS: Eligible patients were aged 18-65 years with stage II-IV untreated DLBCL and an International Prognostic Index (IPI) score of 3-5. Patients received alternating cycles of CODOX-M (cyclophosphamide, vincristine, doxorubicin and high-dose methotrexate) alternating with IVAC chemotherapy (ifosfamide, etoposide and high-dose cytarabine) plus eight doses of rituximab. Response was assessed by computed tomography after completing all four cycles of chemotherapy. The primary end point was 2-year progression-free survival (PFS). RESULTS: A total of 111 eligible patients were registered; median age was 50 years, IPI score was 3 (60.4%) or 4/5 (39.6%), 54% had a performance status ≥2 and 9% had central nervous system involvement. A total of 85 patients (76.6%) completed all four cycles of chemotherapy. There were five treatment-related deaths (4.3%), all in patients with performance status of 3 and aged >50 years. Two-year PFS for the whole cohort was 67.9% [90% confidence interval (CI) 59.9-74.6] and 2-year overall survival was 76.0% (90% CI 68.5-82.0). The ability to tolerate and complete treatment was lower in patients with performance status ≥2 who were aged >50 years, where 2-year PFS was 43.5% (90% CI 27.9-58.0). CONCLUSIONS: This trial demonstrates that R-CODOX-M/R-IVAC is a feasible and effective regimen for the treatment of younger and/or fit patients with high-risk DLBCL. These encouraging survival rates demonstrate that this regimen warrants further investigation against standard of care. TRIAL REGISTRATION: ClinicalTrials.gov (NCT00974792) and EudraCT (2005-003479-19).
Item Type: |
Article
|
Additional Information: |
© 2020 The Authors. Published by Elsevier Ltd on behalf of European Society for Medical Oncology. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
Keywords: |
R-CODOX-M, chemotherapy, diffuse large B-cell lymphoma (DLBCL), double-hit, high-grade B-cell lymphoma, chemotherapy, diffuse large B-cell lymphoma (DLBCL), double-hit, high-grade B-cell lymphoma, R-CODOX-M, 1112 Oncology and Carcinogenesis, Oncology & Carcinogenesis |
SGUL Research Institute / Research Centre: |
Academic Structure > Institute of Medical & Biomedical Education (IMBE) Academic Structure > Institute of Medical & Biomedical Education (IMBE) > Centre for Clinical Education (INMECE ) |
Journal or Publication Title: |
Ann Oncol |
ISSN: |
1569-8041 |
Language: |
eng |
Dates: |
Date | Event |
---|
September 2020 | Published | 26 May 2020 | Published Online | 7 May 2020 | Accepted |
|
Publisher License: |
Creative Commons: Attribution 4.0 |
Projects: |
Project ID | Funder | Funder ID |
---|
LLR04058 | Bloodwise | UNSPECIFIED |
|
PubMed ID: |
32464282 |
Web of Science ID: |
WOS:000562396600021 |
![](http://static.pubmed.gov/portal/portal3rc.fcgi/2745237/img/27842) |
Go to PubMed abstract |
URI: |
https://openaccess.sgul.ac.uk/id/eprint/112493 |
Publisher's version: |
https://doi.org/10.1016/j.annonc.2020.05.016 |
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