Biweekly rituximab, cyclophosphamide, vincristine, non‐pegylated liposome‐encapsulated doxorubicin and prednisone (R‐COMP‐14) in elderly patients with poor‐risk diffuse large B‐cell lymphoma and moderate to high ‘life threat’ impact cardiopathy

Abstract

This Phase II study assessed feasibility and efficacy of a biweekly R-COMP-14 regimen (rituximab, cyclophosphamide, non-pegylated liposome-encapsulated doxorubicin, vincristine and prednisone) in untreated elderly patients with poor-risk diffuse large B-cell lymphoma (DLBCL) and moderate to high ‘life threat’ impact NIA/NCI cardiac comorbidity. A total of 208 courses were delivered, with close cardiac monitoring, to 41 patients (median age: 73 years, range: 62–82; 37% >75 years) at a median interval of 15·6 (range, 13–29) days; 67% completed all six scheduled courses. Response rate was 73%, with 68% complete responses (CR); 4-year disease-free survival (DFS) and time to treatment failure (TTF) were 72% and 49%, respectively. Failures were due to early death (n = 3), therapy discontinuations (no-response n = 2; toxicity n = 6), relapse (n = 6) and death in CR (n = 3). Incidence of cardiac grade 3–5 adverse events was 7/41 (17%; 95% confidence interval: 8–31%). Time to progression and overall survival at 4-years were 77% and 67%, respectively. The Age-adjusted Charlson Comorbidity Index (aaCCI) correlated with failures (P = 0·007) with patients scoring ≤7 having a longer TTF (66% vs. 29%; P = 0·009). R-COMP-14 is feasible and ensures a substantial DFS to poor-risk DLBCL patients who would have been denied anthracycline-based treatment due to cardiac morbidity. The aaCCI predicted both treatment discontinuation rate and TTF.

Diffuse Large B-cell Lymphoma in the Elderly: A Review of Potential Difficulties

“…However, cardiac toxicity persisted with 21% of cardiac events, grade 3 to 4 in 4% of cases. A larger study with the same regimen given every 2 weeks showed a 4-year time-to-treatment-failure of only 49% (64). Another study used a reduced dose of nonpegylated liposomal doxorubicin (30 mg/m 2 ) in 35 frail elderly patients and obtained favorable results considering this frail population with little toxicity (69% CR in intention-to-treat analysis and 2-year overall survival of 70%; ref.…”

Analysis of the Treatment of Diffuse Large B-Cell Lymphoma in Patients with Preexisting Systolic and/or Diastolic Dysfunction at Moffitt Cancer Center

“…In this case a combination of Rituximab with Ifosfamide, Carboplatine and Etoposide (R-ICE) is frequently used with good results [10]. There are several other published regimens but no formal comparison between them [11][12][13][14].…”

My Treatment Approach to Patients With Diffuse Large B-Cell Lymphoma

“…A number of approaches have been proposed to treat these patients. These include deleting doxorubicin from CHOP-R, substituting mitoxantrone for doxorubicin, substituting liposome-encapsulated doxorubicin, 55 substituting etoposide for doxorubicin, using bendamustine-R, 56 and substituting procarbazine for doxorubicin. 2 The approach that I have adopted was recently reported by the Vancouver group.…”