Low-intensity chemo effective for adult Burkitt's lymphoma

In collaboration with the Press Association

Reducing the intensity of chemotherapy could reduce side effects for adult patients with Burkitt's lymphoma without compromising their survival, according to US researchers.

Such lower-intensity treatment could be particularly useful in parts of Africa, where Burkitt's lymphoma is more common and healthcare resources are more limited.

"It's very important for doctors to be able to minimise side effects their patients are exposed to" - Liz Woolf, Cancer Research UK

Treatment usually involves brief exposure to high-dose chemotherapy, but this can be less effective and cause more serious side effects in adults and those with weakened immune systems than in children.

Burkitt's lymphoma is a cancer of the lymphatic system. This is part of the body's immune system and helps fight infection.

Although rare, the disease affects around 200 people in the UK each year. Around a quarter of cases are in children, but the disease is often curable in this group.

The disease is commonly linked to infection with the Epstein-Barr virus, and can occur in patients with weakened immune systems, such as people infected with HIV.

Scientists at the National Cancer Institute in Maryland treated 30 adult patients with chemotherapy regimens that involved longer exposures to lower concentrations of drugs.

The trial, published in the New England Journal of Medicine, involved two variants of EPOCH-R, a chemotherapy regimen that includes the drugs etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab.

Nineteen HIV-negative patients received dose-adjusted (DA)-EPOCH-R. Adjustment of dose levels is done to try to provide the right amount of drug based on a person's tolerance of chemotherapy.

And eleven HIV-positive patients received SC-EPOCH-RR, which is a short-course version of EPOCH-R that includes two doses of rituximab per treatment cycle and has a lower treatment intensity than DA-EPOCH-R.

Follow-up checks on the patients, who had an average age of 33, showed survival rates of 90 per cent in the HIV patients and 100 per cent in the other group.

Dr Kieron Dunleavy of the National Cancer Institute, who helped run the study, said: "These promising results with low-toxicity treatment suggest that this approach may be effective and worth investigating in certain geographic and economically challenged regions where Burkitt's lymphoma is highly prevalent as well as in adult populations."

Based on these results, two trials to confirm the effectiveness of EPOCH-R therapy in adult and childhood Burkitt's lymphoma patients are under way.

Liz Woolf, head of Cancer Research UK's patient information website CancerHelp UK, said: "It's very important for doctors to be able to minimise side effects their patients are exposed to because this makes the treatment easier to tolerate and also less likely to lead to longer term complications.

"This is particularly important with this group of patients, many of whom have a weakened immune system and are undergoing treatment in countries where there may be less money to pay for treatment."

Copyright Press Association 2013

References

  • Dunleavy K, et al. (2013). Low-Intensity Therapy in Adults with Burkitt's Lymphoma, New England Journal of Medicine, 369 (20) 1915-1925. DOI: