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Immunochemotherapy remains standard induction for follicular lymphoma
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Nearly 80% percent of patients with high-risk follicular lymphoma treated with CHOP chemotherapy in combination with rituximab or radioimmunotherapy achieved 10-year OS and 49% achieved 10-year PFS, according to a study published in Journal of Clinical Oncology.
Patients treated with CHOP plus radioimmunotherapy showed improved PFS compared with patients treated with CHOP plus rituximab (Rituxan; Genentech, Biogen), or R-CHOP. However, researchers observed no significant difference in OS between the two groups.
“Follicular lymphoma remains an incurable disease, and the goal of treatment is to achieve durable remissions using treatments with minimal short- and long-term complications,” Mazyar Shadman, MD, MPH, medical oncologist at Fred Hutchinson Cancer Research Center, and colleagues wrote. “To date, immunochemotherapeutic regimens are the most effective treatment of follicular lymphoma in the first-line setting. The choice of immunochemotherapy has been the subject of controversy, with limited data regarding the long-term efficacy or toxicity of commonly used regimens.”
Shadman and colleagues of SWOG S0016 randomly assigned 531 previously untreated patients with follicular lymphoma to receive six cycles of CHOP with either rituximab — a monoclonal anti-CD20 antibody — or followed by consolidation with iodine-133-tositumomab radioimmunotherapy.
Median follow-up was 10.3 years.
Across both treatment arms, 10-year PFS was 49% (95% CI, 44.6-53.5) and 10-year OS was 78% (95% CI, 74.4-81.8).
More patients treated with CHOP plus radioimmunotherapy achieved 10-year PFS than those treated with R-CHOP (56% vs. 42%; P = .01). However, 10-year OS did not appear different between the two groups (75% vs. 81%).
Researchers did not observe a significant difference in incidence of second malignancies (15.1% vs. 16.1%) or myelodysplastic syndrome or acute myeloid leukemia (4.9% v 1.8%) between the two treatment groups.
Researchers also did not observe a significant difference in the estimated 10-year cumulative incidences of death of second malignancies with CHOP followed by radioimmunotherapy compared with R-CHOP (7.1% vs. 3.2%). However, patients treated with CHOP followed by radioimmunotherapy appeared to have a higher cumulative incidence of death resulting from myelodysplastic syndrome or AML (4% vs. 0.9%; P = .02).
“Although the introduction of novel and noncytotoxic therapeutic agents may change future treatment options, chemoimmunotherapy offers outstanding long-term disease control and survival, with almost half of patients in S0016 still progression free after a single line of treatment with 10 years of follow-up,” the researchers wrote. “Given these outstanding outcomes, immunochemotherapy should remain the standard induction approach for patients with high-risk follicular lymphoma, with CHOP-based regimens as viable alternatives to bendamustine-based regimens.” – by Cassie Homer
Disclosures: Shadman reports a consultant/advisory role with AbbVie and institutional research funding from Acerta Pharma, Celgene, Genentech, Gilead Sciences, Merck, Pharmacyclics and TG Therapeutics. Please see the study for a list of all other authors’ relevant financial disclosures.
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