December 02, 2020
For patients with high-risk diffuse large B-cell lymphoma (DLBCL) who are younger and fit, R-CODOX-M/R-IVAC is a feasible and effective regimen, researchers reported in the Annals of Oncology.
“Outcomes for patients with high-risk DLBCL treated with R-CHOP chemotherapy are suboptimal but, to date, no alternative regimen has been shown to improve survival rates,” they wrote. “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.”
The study included 111 adults up to age 65 with stage II-IV untreated DLBCL. The median patient age was 50 years, 60% had an International Prognostic Index (IPI) score of 3, and 54% had performance status of 2 or greater.
Patients received alternating cycles of CODOX-M (cyclophosphamide, vincristine, doxorubicin, and high-dose methotrexate) and IVAC chemotherapy (ifosfamide, etoposide, and high-dose cytarabine), plus eight doses of rituximab. Their response was assessed using computed tomography after four cycles of chemotherapy.
Of 111 enrolled patients, 85 completed all four cycles of chemotherapy. The ability to tolerate and finish treatment was lower in patients with a performance status of 2 or more who were older than 50 years, according to the study. Five patients died of treatment-related causes, all of whom had a performance status of 3 and were older than 50 years.
For the entire cohort, 2-year progression-free survival was 67.9% and overall survival was 76%, researchers reported. Two-year progression-free survival in patients older than 50 with a performance status of 2 or more was 43.5%.
“These encouraging survival rates demonstrate,” researchers concluded, “that this regimen warrants further investigation against standard of care.”
McMillan AK, Phillips EH, Kirkwood AA, et al. 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. 2020;31(9):1251-1259. doi:10.1016/j.annonc.2020.05.016