DLBCL: dose-adjusted EPOCH-R more toxic than R-CHOP

  • Bartlett NL & al.
  • J Clin Oncol
  • 2 Apr 2019

  • curated by David Reilly
  • Univadis Clinical Summaries
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Takeaway

  • Frontline dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (DA-EPOCH-R) was associated with greater toxicity than standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), and failed to confer a survival advantage in diffuse large B-cell lymphoma (DLBCL).

Why this matters

  • Evidence suggested that the DA-EPOCH-R regimen may be linked to less tumor resistance and reduced cardiotoxicity.

Study design

  • Phase 3 study (Intergroup Trial Alliance/CALGB 50303) to investigate DA-EPOCH-R vs standard R-CHOP as frontline therapy in 491 patients with DLBCL.
  • Funding: National Cancer Institute.  

Key results

  • 88.0% overall response with R-CHOP vs 86.7% with DA-EPOCH-R (P=.67).
    • 59.6% complete response/complete response unconfirmed with R-CHOP vs 58.5% with DA-EPOCH-R (P=.67).
  • No significant difference in PFS by treatment group (DA-EPOCH-R; HR, 0.93; 95% CI, 0.68-1.27; P=.65).
  • 75.5% (95% CI, 70.2%-81.1%) 2-year PFS with R-CHOP vs 78.9% (95% CI, 73.8%-84.2%) with DA-EPOCH-R.
  • No significant difference in OS by treatment group (DA-EPOCH-R; HR, 1.09; 95% CI, 0.75-1.59; P=.64).
  • 78.5% 5-year OS with R-CHOP vs 77.5% with DA-EPOCH-R.
  • 98.3% of patients receiving DA-EPOCH-R experienced grade 3-5 treatment-associated adverse events vs 78.2% of patients receiving R-CHOP (P<.001>

Limitations

  • Patients with high-risk disease were underrepresented.

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