Modified Chemotherapy Regimen Offers New Treatment Option For Very Elderly Patients With Aggressive Type Of Non-Hodgkin's Lymphoma

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Blank Modified Chemotherapy Regimen Offers New Treatment Option For Very Elderly

Patients With Aggressive Type Of Non-Hodgkin's Lymphoma

07 Apr 2011

Lymphoma in elderly patients is particularly difficult to treat because of

their reduced ability to tolerate chemotherapy*. But a large phase 2 trial,

published Online First in The Lancet Oncology, reports that a modified treatment

approach using a decreased dose of conventional chemotherapy combined with a

standard dose of rituximab was well tolerated and yielded a substantial

response** and improved survival in very elderly patients with diffuse large

B-cell lymphoma, a common and very aggressive form of non-hodgkin's lymphoma.

These findings suggest for the first time that a large proportion of patients

older than 80 years with diffuse large B-cell lymphoma can be cured, and that

this new regimen should become the standard treatment in these patients.

Diffuse B-cell lymphoma is a common cancer in the elderly, and with the increase

in life expectancy of the general population, cases are set to rise. Over the

past decade, combining the monoclonal antibody rituximab with the standard

chemotherapy regimen CHOP (doxorubicin, cyclophosphamide, vincristine, and

prednisone) has significantly improved survival in patients younger than 80

years. However, trials have not included patients over 80 years. A small

retrospective study suggested that in patients older than 80 years a

reduced-dose standard chemotherapy regimen might increase tolerability while

maintaining efficacy.

In this study, a team led by Frédéric Peyrade from Onco-Hematology Centre

regional de Lutte contre le cancer de Nice, Nice, France investigated the

efficacy and safety of the combination of a low-dose of CHOP chemotherapy with a

standard dose of rituximab R-miniCHOP) in patients over 80 years with diffuse

B-cell lymphoma. Between 2006 and 2009, 150 patients were enrolled from 38

centres across France and Belgium and given six cycles of R-miniCHOP at 3 week

intervals.

Overall response rates achieved were 73%, and the complete or unconfirmed

complete response rate was 62%.

With a median follow-up of 20 months, median overall survival was 29 months and

the 2-year overall survival rate was 59%.

The R-miniCHOP regimen was well tolerated, allowing administration of the full

planned dose in 72% of the patients. A very low number of hospital admissions

and a low number of deaths (12) were attributed to treatment toxicity.

The authors conclude: " R-miniCHOP offers a good compromise between efficacy and

safety...and should be the standard treatment for patients older than 80 years

who have diffuse large B-cell lymphoma and a good performance status " .

In a Comment, p- Ribera from Institut de Recerca Contra la Leucèmia

p Carreras, Universitat Autònoma de Barcelona, Spain says: " These

results...provide hope for very elderly patients with diffuse large B-cell

lymphoma - a group that is frequently excluded from clinical trials. "

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