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Combination therapy plus WBRT effective in CNS lymphoma
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Patients with newly-diagnosed primary central nervous system lymphoma demonstrated high response rates after induction chemotherapy with rituximab, methotrexate, procarbazine and vincristine, followed by reduced-dose whole-brain radiation therapy and cytarabine, according to results of a phase 2 study.
The analysis included 52 patients with treatment-naive CNS lymphoma. The median age of patients was 60 years (range, 30 to 79).
All patients underwent five 14-day cycles of induction chemotherapy with rituximab (Rituxan, Genentech/Biogen Idec Pharmaceuticals), methotrexate, procarbazine and vincristine.
Thirty-four patients (79%) achieved complete response and seven (16%) achieved partial response.
Patients who achieved complete response underwent reduced-dose whole-brain radiation therapy (WBRT) of 23.4 Gy, administered in 13 fractions of 1.8 Gy. The remainder of patients underwent standard WBRT of 45 Gy, administered in 25 fractions. All patients received consolidation cytarabine after radiotherapy.
Median follow-up was 5.6 years for all patients. Researchers reported median PFS of 3.3 years and median OS of 6.6 years.
Median follow-up was 5.9 years among the 31 patients who underwent reduced-dose WBRT. In that group, researchers reported a median PFS of 7.7 years. Median OS was not reached. Researchers reported a 2-year PFS rate of 77% (95% CI, 63-92) and a 5-year OS rate of 80% (95% CI, 66-94).
Twelve patients (median age, 58 years) who underwent reduced-dose WBRT were progression free and completed neuropsychological evaluations up to 48 months. Among this group, researchers noted significant improvement in executive (P<.01) and verbal (P<.05) memory after induction chemotherapy. Researchers observed no evidence of significant cognitive decline with the exception of motor speed (P<.05).
“Therapeutic options for primary CNS lymphoma have been expanding over the years. Patients are surviving longer, and there is reason for optimism,” the researchers wrote. “Our study adds to the existing therapeutic arsenal for newly-diagnosed patients, providing an alternative treatment option that could potentially benefit patients of all ages.”
Disclosure: The researchers report employment, leadership positions or advisory roles with, stock ownership in, and honoraria or other remuneration from Genentech, Nordic Group, Novartis, OncologySTAT and Roche.
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