CVP chemotherapy plus rituximab compared with CVP as first-line treatment for advanced follicular lymphoma

Abstract

The combination of cyclophosphamide, vincristine, and prednisone (CVP) is one of several standard treatment options for advanced follicular lymphoma. This, like similar chemotherapeutic regimens, induces response rates of 60% to 80%, with a median response duration of under 2 years. Rituximab, a chimeric monoclonal antibody against CD20, is active in follicular lymphoma, both as monotherapy and in combination with chemotherapy. Previously untreated patients with stages III to IV follicular lymphoma were randomly assigned to receive either 8 cycles of CVP plus rituximab (R-CVP; n ‫؍‬ 162) or CVP (n ‫؍‬ 159). Overall and complete response rates were 81% and 41% in the R-CVP arm versus 57% and 10% in the CVP arm, respectively (P < .0001). At a median follow-up of 30 months, patients treated with R-CVP had a very significantly prolonged time to progression (median 32 months versus 15 months for CVP; P < .0001). Median time to treatment failure was 27 months in patients receiving R-CVP and 7 months in the CVP arm (P < .0001). Rituximab did not add significantly to the toxicity of CVP.

Improved survival for non-Hodgkin lymphoma patients in New South Wales, Australia

“…Indeed, the therapeutic monoclonal antibody, rituximab, was introduced into clinical use in Australia initially for patients with relapsed or refractory indolent B-cell NHL (follicular or small lymphocytic subtypes) in 1998, and then for patients with diffuse large B-cell lymphoma (the commonest type of aggressive NHL) in early 2002. The use of rituximab for treating B-cell NHL has been wide spread in Australia (Figure 3) as universal health coverage is available and, consistent with findings from clinical trials, the improved survival was mainly seen in B-cell lymphomas and was of a similar magnitude to that reported in the trials [23,39]. It is likely that these 5-year relative survival estimates in 2000-2004 derived by period analysis underestimate the true later observed relative survival [40] given the rapid increase in the use of rituximab for treatment of NHL in Australia.…”

Rituximab maintenance improves overall survival in follicular lymphoma: A retrospective nationwide real‐world analysis from Taiwan Cancer Registry Database

“…On the contrast, patients with asymptomatic advanced‐stage FL do not need to be treated immediately 1, 5, 6, 7. Once they develop symptoms, chemotherapies with rituximab are suggested as frontline treatments 1, 4, 8, 9, 10, 11…”

“…Rituximab combined with cytotoxic chemotherapies is superior to chemotherapies alone, regardless of frontline treatments or in relapse and/or refractory FL 8, 9, 10, 12, 13, 14, 15. Several prospective trials tried to address the clinical benefits of rituximab maintenance in the patients with FL, but rituximab maintenance only improves progression‐free survival instead of overall survival 16, 17, 18, 19.…”

Gemcitabine, cisplatin and methylprednisolone (GEM-P) is an effective salvage regimen in patients with relapsed and refractory lymphoma

“…The adoption of ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine) as standard first-line therapy for advanced HL has led to higher response rates (RRs) with less treatment related toxicity (Canellos et al, 1992). The addition of rituximab to conventional chemotherapy has improved RRs and time to treatment failure in follicular lymphoma (Marcus et al, 2003), while also improving overall survival in diffuse large B-cell lymphoma (DLBCL) (Coiffier et al, 2002). Despite these improvements in treatment, approximately 50% of patients with advanced disease will relapse or fail treatment with first line chemotherapy (Fisher et al, 1994;Canellos and Niedzwiecki, 2002;Coiffier et al, 2002).…”