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Denser rituximab no extra help in B-Cell lymphoma

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – In patients with indolent non-Hodgkin’s B-cell lymphoma, a more intensive regimen of rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) does not prompt improvement, Japanese researchers report in a September 19th on-line paper in the Journal of Clinical Oncology.

The question posed was whether a 14-day cycle (R-CHOP-14) would be more effective than a 21 day cycle (R-CHOP-21). As Dr. Takashi Watanabe told Reuters Health by email, “Is R-CHOP-21 the standard of care for patients with previously untreated advanced-stage indolent B-cell non-Hodgkin’s lymphoma?”

The outcome of follicular lymphoma is improved with use of rituximab.In fact, in an accompanying podcast, Dr. Jonathan Friedberg of the University of Rochester, New York pointed out that because of the beneficial results “whenever chemotherapy is used in this disease it should be combined with rituximab. The most widely used regimen in the US has been R-CHOP” on a 21-day schedule.

In the current study, the researchers randomized 300 patients to 6 cycles of R-CHOP every 3 weeks (R-CHOP-21) or every 2 weeks (R-CHOP-14) along with granulocyte colony stimulating factor.

At a median follow-up of 5.2 years, the median progression-free survival was 3.7 years in the R-CHOP-21 group and 4.7 years in the R-CHOP-14 group – a non-significant difference. Proportions at 3 years (57% and 58%) and at 6 years (41% and 43%) were almost identical.

The median overall survival time was not reached but 6-year overall survival was 87% in R-CHOP-21 and 88% in R-CHOP-14.

Dr. Friedberg pointed out that “The outcome of patients treated with R-CHOP is extremely favorable and it is challenging to improve on a therapy where over 40% of patients remain in remission after 6 years of treatment.”

In email comments to Reuters Health, he added that the trial was rigorously performed. “With adequate follow-up, there was no significant difference in progression free survival or overall survival. Therefore, there is no reason to switch to R-CHOP on a 14 day schedule.”

Reference:

Phase II/III Study of R-CHOP-21 Versus R-CHOP-14 for Untreated Indolent B-Cell Non-Hodgkin’s Lymphoma: JCOG 0203 Trial

J Clin Oncol 2011.