ASH 2018 — 4 cycles of R-CHOP as good as 6 for DLBCL


  • Wayne Kuznar
  • Univadis
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Takeaway

  • Four cycles of R-CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone+rituximab)+2 cycles of rituximab (2R) is noninferior to 6 cycles of R-CHOP in patients with favorable prognosis diffuse large B-cell lymphoma (DLBCL).

Why this matters

  • The current standard of treatment in low-risk DLBCL is 6 cycles of R-CHOP.
  • Reducing CHOP cycles reduces toxicity.

Study design

  • FLYER phase 3 international multicenter trial of 592 patients aged 18-60 years with nonbulky DLBCL, randomly assigned to 4 cycles of R-CHOP+2R or the standard 6 cycles of R-CHOP.
  • Median follow-up, 66 months.
  • Funding: Deutsche Krebshilfe.

Key results

  • 3-year PFS rate was similar between groups (96% vs 94%; P=.797).
  • 3-year OS rate was similar between groups (99% vs 98%; P=.671).
  • Relapse rates were also similar (4% vs 5%).
  • Limiting chemotherapy reduced the incidence of hematologic and nonhematologic events by about one-third.

Limitations

  • All patients had favorable prognostic characteristics.

Expert comment

  • "For this well-defined subgroup of patients, it appears that we can make their treatment shorter and have less burden but equivalent efficacy," said David Steensma, MD, Dana-Farber Cancer Institute, Boston, Massachusetts. "I think this will immediately influence clinical practice."