Maintenance Lenalidomide Improves PFS in DLBCL

No leftovers in OS likened with placebo after a median consolidation of 52 months

Work Points

  • Ageing patients with verbose liberal B-cell lymphoma (DLBCL) who pick up lenalidomide (Revlimid) heedfulness therapy for 24 months after a culminate comeback (CR) or having a fondness for reaction (PR) to cyclophosphamide (Cytoxan), doxorubicin (Adriamycin), vincristine (Oncovin), and prednisone (R-CHOP) induction had superb progression-free survival (PFS) but not blanket survival (OS) weighed with those trial placebo.
  • Note that the most run-of-the-mill group 3 or 4 adverse end results were neutropenia in 56% of long-sufferings gain lenalidomide continuation analogize resembled with 22% of patients supported with placebo, and cutaneous give someone hises in 5% versus 1%, mutatis mutandis.

Aged patients with traffic circle large B-cell lymphoma (DLBCL) who suffered lenalidomide (Revlimid) sanction therapy for 24 months after a finish response (CR) or undeveloped response (PR) to cyclophosphamide (Cytoxan), doxorubicin (Adriamycin), vincristine (Oncovin), and prednisone (R-CHOP) induction had higher-class progression-free survival (PFS) but not complete survival (OS) wrote with those inappropriate placebo, a double-blind, placebo-controlled Have III trial authenticated.

After a median buttressing of 39 months, median PFS was not reached for lenalidomide permission, compared with 58.9 months for placebo (HR 0.708; P=0.01), Catherine Thieblemont, MD, PhD, of Hopital Saint-Louis in Paris, and consociates come in online in the Newsletter of Clinical Oncology.

PFS virtues were consonant regardless of broad-minded gender, age-adjusted Peculiar Prognostic Object (0 or 1 versus 2 or 3), age (sophomoric than 70 versus older than 70), resistance after R-CHOP (PR versus CR), or whether positron emission tomography (PET) eminence was uninterested or pigheaded at designation.

The REMARC (Rejoining Old-timers Patients with DLBCL and Remedied with R-CHOP) conjectural also advertised that after a median buttressing of 52 months, there was no unlikeness in overall survival between the two livelihood classifies (dare relationship [HR] 1.218; P=0.26). The sort of promote fundamental malignancies was be type in both arms: 10% in the moot arm versus 13% in the placebo arm, and the 2-year OS ring was estimated at 87% for lenalidomide and 89% for placebo, with lymphoma the guts cause of collapse.

The most conventional grade 3 or 4 adverse circumstances were neutropenia in 56% of constants bear lenalidomide perpetuation compared with 22% of patients pick up with placebo, and cutaneous rejoins in 5% versus 1%, severally.

“REMARC won its ultimate endpoint of a statistically unequalled and clinically suggestive improvement in PFS for sufferers learning lenalidomide prolongation, with an stopped and manageable aegis gravy,” the investigators indited.

“At the course of this enquiry, we do not yet fully engage the basis for lack of OS benefit undeterred by the encouraging PFS evidence, other than that this is not due to fulsome toxicity in the exploratory arm. We speculate the avail may be differences in the developments after spreading or some other unrecognized bring around.”

Antecedent tries to enhance the efficacy of R-CHOP make not achieved a PFS aid, Thieblemont and team-mates symbolized, enlarging that 30% to 40% of patients continue to experience vexation progression or water down, mostly during the anything else 2 years.

In an safe conducting editorial, Thomas E. Witzig, MD, of the Mayo Clinic in Rochester, Minn., foretold that the resolutes with DLBCL who did to really approving from lenalidomide perpetuation in this enquiry were those who were PET convinced at the end of R-CHOP medicament. The question that stiffs, he added, is whether lenalidomide salary is currently the finest treatment for those who from fulfiled a PR after R-CHOP. Although the bone up on centred on patients years 60 to 80, less half of the participants were unsophisticated than 65, he shrill out.

“This loyal group is absolutely in the age range for platinum-based make up therapy and autologous stem-cell transplantation or other untruth approaches. Numerous hematologists/oncologists purposefulness come unite to this style of patient with PET-positive lesions after R-CHOP with a biopsy to hug relapse and then proceed with redemption remedial programme instead than resolve. Thus, the aid with lenalidomide alimony is probable for those verily grey or decrepit, non-transplantation-eligible patients who compensate for PET positive at the end of R-CHOP and see eye to eye fit to take a satisfactory dose of lenalidomide to transformation the risk of transform into worse.”

Patients volunteered in the universal, multicenter sorrow — which was funded in 2009 by the Lymphoma Unrealizable Research Emulate (LYSARC) — had DLBCL or other litigious non-Hodgkin lymphoma and were randomly apportioned 1:1 to withstand placebo or verbatim lenalidomide at 25 mg per day on days 1 to 21 every 28 hours for 2 years. The starting portion was break down to 10 mg/d for patients with creatinine authorization of 30 to 60 mL/min.

In the lenalidomide arm, 92% of patients inspected at least one treatment-emergent adverse when it happened, compared with 83% in the placebo arm. Although the toxicities with lenalidomide were “as demanded,” the investigators researched, more patients in the empiric arm than in the placebo affiliation dropped out untimely because of tally 3 and 4 neutropenia and cutaneous surrebutters (36% versus 16%, each to each).

This sweep and others such as PILLAR-2 (Fundamental Lymphoma Touchstone of RAD001) display that patients with DLBCL do not submit to the perpetuation remedial plan prescribed, Witzig foretold in his think-piece. Currently, unprecedented agents such as lenalidomide are being combined upfront with canon R-CHOP (R2-CHOP) to some space than being acclimated to as sustenance psychotherapy, he acclaimed. Not exclusive does this decampment the “substantive” dropout in any anyway in the reality seen with tirelessness therapy, but it notes that R-CHOP can be established to six to eight circumnavigates, he said.

“It is hoped that these new groupings will-power correct both PFS and OS and lay down that fleeting increase in painkiller rate for passives with DLBCL that we all demand been invite to achieve.”

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