Trial finds new drug combo increases remission time for lymphoma patients

In collaboration with the Press Association

A trial led by French researchers has found that patients under 60 with a form of non-Hodgkin's lymphoma called 'diffuse large B-cell lymphoma' are more likely to have a longer remission if they were given a combined treatment of the drug rituximab with a more intensive regimen of chemotherapy.

But the intensive treatment led to more serious side effects, and researchers warned that it may only be suitable for patients at high risk of relapse.

The Groupe d'Etude des Lymphomes de l'Adulte study, published online in the Lancet, found that patients between 18 and 59 years old, who were given higher doses of chemotherapy with shorter intervals between treatments were around twice as likely to stay in remission compared with patients given standard chemotherapy plus rituximab.

The trial, which was carried out over the past decade, assigned 379 patients with early intermediate-stage diffuse large B-cell lymphoma either four cycles of dose-intensive chemotherapy of doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone plus rituximab (R-ACVBP) at two-week intervals, or eight cycles of the standard treatment, known as R-CHOP, at three-week intervals.

It found that, after three years, patients in the intensive treatment group were more likely to have a lasting remission those receiving standard treatment.

The researchers also found that patients with the cancer - which is one of the most common and aggressive forms of non-Hodgkin's lymphoma - who were assigned to the intensified treatment had a 56 per cent lower risk of death over the study period.

While researchers agreed that the combined treatment represents an alternative to R-CHOP to improve survival rates in younger patients, they warned that increasing the treatment intensity also significantly increased the likelihood of serious side effects.

Writing in a comment piece in the same issue of the Lancet, US clinician Professor Julie Vose said: "This dose-intense regimen should only be used in patients in whom the expected relapse rate is sufficient to justify the higher toxic effects and cost profile."

Martin Ledwick, head information nurse at Cancer Research UK, agreed.

"This research could benefit some patients with this type of lymphoma", he said. "But, as the authors acknowledge, there are risks associated with this treatment and it will be important for doctors to select patients carefully."

The Haematological Malignancy Research Network estimates that around 4,600 people in the UK get diffuse large B-cell lymphoma every year.

Copyright Press Association 2011

References

  • Récher, C et al, Intensified chemotherapy with ACVBP plus rituximab versus standard CHOP plus rituximab for the treatment of diffuse large B-cell lymphoma (LNH03-2B): an open-label randomised phase 3 trial, Lancet 2011; 378: 1858–6