Selective benefit in high-risk patients, but won’t alter clinical practice

The basis for the increased risks of cytomegalovirus and P. carinii infections with DENSE-R-CHOP-14 was puzzling, said Dr. Zelenetz of Memorial Sloan Kettering Cancer Center. “Increasing the dose density of rituximab should probably more effectively eliminate B cells. I understand that. But these are both T-cell-mediated infections.”

Dr. Zelenetz concurred that the study succeeded in meeting its primary endpoint of achieving more consistent rituximab pharmacokinetics. And DENSE-R-CHOP-14 does appear to selectively benefit higher-risk patients, although he cautioned that these were subset analyses.

“This is really very interesting data, but with the increased toxicity, should it change clinical practice today?” he asked. “I would say no, not at this time. I think randomized trials will be necessary to validate these findings.”