Nonpegylated liposomal doxorubicin (Myocet™) combination (R-COMP) chemotherapy in elderly patients with diffuse large B-cell lymphoma (DLBCL): results from the phase II EUR018 trial

Abstract

R-COMP is an effective regimen for the treatment of DLBCL in elderly patients, with an acceptable tolerability profile.

Activity and safety of dose‐adjusted infusional cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy with rituximab in very elderly patients with poor‐prognostic untreated diffuse large B‐cell non‐Hodgkin lymphoma

“…As expected, the most frequent grade 3 to 4 AEs were neutropenia and febrile neutropenia, which occurred in 48% and 13% of patients, respectively. However, the observed rates of AEs with DA-POCH-R did not differ from those reported in other dose-adjusted regimens [14][15][16][17] and were substantially lower than AE rates observed in a series of doxorubicin-free protocols [31][32][33][34][35][36][37][38][39][40]42,44 specifically tailored for elderly patients with DLBCL (Table 6).…”

“…The rate of cardiac toxicity recorded in our study is also among the lowest recorded when compared with results of other trials investigating R-CHOP, or R-CHOP-like regimens, in elderly patients with DLBCL. 18,[30][31][32]44 In our study, multivariate analysis revealed that the need for chemotherapy dose reduction was the only predictive factor of poor outcome, independently of age. Back in the days of first-generation chemotherapeutic regimens, when in a Southwest Oncology group (SWOG) study CHOP chemotherapy was reduced by 50% in patients over 65 years of age, CR rates declined.…”

“…18 Our results for the DA-POCH-R regimen can also be considered promising if we take into account the fact that our patients had a median age of 77 years, ranging from 70 to 90, which is higher than all others trials that investigated chemotherapy regimens in elderly patients with DLBCL. 31,44 The DA-POCH-R treatment was found to be feasible and well tolerated, even in patients who had either a very advanced age (>80 years) or comorbidities. As expected, the most frequent grade 3 to 4 AEs were neutropenia and febrile neutropenia, which occurred in 48% and 13% of patients, respectively.…”

“…31 The use of liposome-encapsulated doxorubicin was also tested with encouraging results in patients with DLBCL and with concurrent cardiac disease or pretreated with anthracyclines, 41 in frail patients with DLBCL, 42 and in patients with AIDS-related nonHodgkin lymphoma. 43 In a series of untreated DLBCL patients aged over 60 years, 44 substitution of the nonpegylated liposomal doxorubicin, Myocet TM , for doxorubicin (5) 1 (8) 4 (5) 1 (10) 2 (4) NS Anemia 3 (13) 5 (4) 2 (15) 3 (4) 1 (10) 2 (4) NS Neutropenic fever 3 (13) 8 (6) 1 (8) 4 (5) 2 ( in the standard R-CHOP showed similar efficacy (Table 6). Twenty-one percent of these patients experienced cardiac adverse events, graded as 3 to 4 in 4% of the cases.…”

Anthracycline cardiotoxicity

“…Cardiotoxicity was low and a promising response rate was observed in this setting patients. Another interesting study regarding the safety and the efficacy of the R-COMP combination was recently published (Luminari et al, 2010). Seventy-five elderly patients with diffuse large B-cell lymphoma (DLBCL) were studied.…”