SAN FRANCISCO—Rituximab (Rituxan) plus CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) is the standard induction therapy for patients with advanced-stage diffuse large B-cell lymphoma, including both elderly and younger patients.
"In every parameter of note, R-CHOP produces major benefit in these patients," said Richard I. Fisher, MD, professor of medicine and director of the James P. Wilmot Cancer Center at the University of Rochester Medical Center.
In a presentation at the 3rd Annual Oncology Congress, Dr. Fisher pointed to the phase III GELA (Groupe d'Etude des Lymphomes de l'Adulte) trial, which compared R-CHOP with CHOP alone in elderly DLBCL patients (Coiffier et al: N Engl J Med 346:235-242, 2002).
At a median follow-up of 11.5 months, overall survival was 83% in the R-CHOP group vs 68% with CHOP alone (P < .001). Event-free survival (68% vs 49%, P < .0005) and complete response rates (76% vs 60%, P < .004) were also significantly higher among the R-CHOP patients. There was no clinically relevant increase in adverse events with R-CHOP.
Dr. Fisher also noted that results have been stable over the years, according to 3- and 5-year follow-up analyses.
A phase III study by Habermann and colleagues of patients 60 years of age or older found a 3-year failure-free survival rate of 53% with R-CHOP, compared with 46% for CHOP alone (P = .04), with a median follow-up of 3.5 years (J Clin Oncol 24:3121-3127, 2006). (This study also included a maintenance phase, discussed below.)
The MInT study
Dr. Fisher also highlighted the MInT Trial (MabThera International Trial), which randomized younger patients (aged 18 to 60) with good prognosis stage II-IV DLBCL (or stage I with bulk) to R-CHOP or CHOP alone. With a median follow-up of 23 months, overall survival was 95% for R-CHOP vs 86% for CHOP alone (P = .0002).