Dose-Adjusted EPOCH-Rituximab Shows Encouraging Results for Patients with Primary Mediastinal B-Cell Lymphoma

Initially recognized in the 1980s, primary mediastinal B-cell lymphoma (PMBCL) is a subtype of diffuse large B-cell lymphoma (DLBCL) arising in the thymus. Representing less than 3% of non-Hodgkin lymphoma cases, PMBCL has a skewed age distribution affecting young adults, especially young women. Historically, patients with PMBCL have been treated with mediastinal radiation following chemotherapy based on evidence that chemotherapy alone was insufficient. Despite the high cure rates with this strategy, mediastinal radiation in young patients can be associated with late adverse effects, including premature cardiovascular disease and secondary cancers.

Researchers from the National Cancer Institute (NCI) and their partner institutions recently completed a phase II study of infusional dose-adjusted etoposide, doxorubicin, and cyclophosphamide with vincristine, prednisone, and rituximab (DA-EPOCH-R) with no mediastinal radiation complement. In 51 patients with a median age of 30 years, of which 59% were women, the overall survival rate was 97% at the median 5-year follow-up. From these results, researchers suggested that DA-EPOCH-R therapy obviated the need for radiotherapy in patients with PMBCL.  

While these results from this phase II study are encouraging, they will need to be confirmed with further research.

OncLive: Dr. John Leonard Discusses What’s New in DLBCL Treatment

At the 16th Annual International Congress on Hematologic Malignancies, Dr. John Leonard, the director of the Lymphoma Program at Weill Cornell Medical College, discussed several novel therapies currently under investigation for DLBCL. Today OncLive published an article, “Beyond R-CHOP-21: What’s New in Diffuse Large B-Cell Lymphoma” summarizing Dr. Leonard’s discussion.

“The current standard for patients with advanced diffuse large B-cell lymphoma (DLBCL) is R-CHOP-21 (21-day rituximab-cyclophosphamidedoxorubicin- vincristine-prednisone). However, while this regimen cures approximately two-thirds of patients, a significant fraction of patients will still relapse, and the prognosis for these patients is poor.”

Approaches being evaluated include substituting an alternate chemotherapy regimen for CHOP in combination with rituximab; R-EPOCH (rituximabetoposide- prednisone-vincristine-doxorubicin-cyclophosphamide); and adding a new agent to R-CHOP-21.

Click here to read the full article in in OncLive.


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