VIDEO: R-CHOP remains standard of care after three studies fail to improve survival in DLBCL

SAN DIEGO — Ajay K. Gopal, MD, director of clinical research at Seattle Cancer Care Alliance, discusses three studies of patients with diffuse large B-cell lymphoma that failed to meet their primary endpoints and were presented at the ASH Annual Meeting and Exposition.

The Goya study — which compared treatment with rituximab (Rituxan; Genentech, Biogen), cyclophosphamide, doxorubicin, vincristine and prednisone, or R-CHOP, with CHOP plus obinutuzumab (Gazyva, Genentech) — failed to demonstrate a significant improvement in PFS or OS in the obinutuzumab arm. The combination also showed an increase in toxicity.

“I think at this point, CHOP with rituximab remains the standard based on this trial,” Gopal added.

In addition, a cooperative group study — designed to compare dose-adjusted etoposide, prednisone, vincristine and doxorubicin, or EPOCH, with R-CHOP — also demonstrated no improvement in PFS or OS compared with the standard of care.

The CLLM1 study — which evaluated lenalidomide (Revlimid, Celgene) maintenance following initial remission induction with R-CHOP — showed an improvement in PFS; however, no difference was found in OS between arms.

“I think this left us all scratching our heads about why [improved PFS] did not translate [into improved OS],” Gopal said. “We’ll need to look at the data a little more closely to understand whether lenalidomide maintenance may benefit some patients after R-CHOP induction.” – by Kristie L. Kahl

Disclosure: Gopal reports consultant roles with Gilead, Janssen, Seattle Genetics and Spectrum; research funding from Bristol-Myers Squibb, Gilead, Janssen, Merck, Pfizer, Seattle Genetics, Spectrum, Takeda and Teva; and honoraria from Seattle Genetics.