A new study presented at ASH 2018 in San Diego suggests the standard course of treatment for younger patients with low-risk DLBCL can safely be reduced by two cycles of chemotherapy. 

The trial, which tracked patients for a median of more than five years and up to 11 years, showed four cycles of chemotherapy is as effective as six cycles in terms of eradicating cancer and preventing relapse.

Researchers said the ability to reduce chemotherapy cycles by one-third is likely to come as welcome news for patients, who often must put their lives on hold as they cope with the side effects of chemotherapy.

Under the reduced regimen, chemotherapy lasts a total of 84 days, compared to 126 days with the six-cycle regimen.

“With a shorter duration of chemotherapy, patients are back to daily life with their families and back to work more quickly,” said lead study author Viola Poeschel, MD, of Saarland University Medical School in Homburg/Saar, Germany.

“Our study shows you can spare two cycles of chemotherapy and it is equally effective. We think this will be the new standard treatment for this patient population.”

DLBCL is a type of non-Hodgkin lymphoma, a cancer of the white blood cells, that tends to grow quickly.

Most patients receive treatment in six cycles spaced three weeks apart.

Each treatment cycle includes a chemotherapy regimen known as CHOP, which includes cyclophosphamide, doxorubicin, vincristine, and prednisone.

Along with CHOP, patients receive rituximab, a monoclonal antibody drug that attacks cancerous cells via a different mechanism. Rituximab is less toxic, and therefore has fewer side effects compared to chemotherapy.

For the study, researchers enrolled nearly 600 patients age 18-60 treated for DLBCL at institutions in Germany, Denmark, Norway, Italy, and Israel.

All patients had stage I or II cancer and were considered to be low-risk.

Half of the patients were randomly assigned to receive six cycles of CHOP and half received four cycles of CHOP. All patients received the standard six cycles of rituximab.

Patients did well with both treatment regimens, and there were no statistically significant differences between the two groups in terms of overall survival, relapse, or disease progression.

Three years after receiving treatment, 99 percent of those receiving four cycles of chemotherapy and 98 percent of those receiving six cycles remained alive.

In addition, the data suggest that reducing the number of chemotherapy cycles also reduces the number of adverse events by one-third.

Altogether, 1,295 adverse events occurred in the 295 patients who underwent six cycles of chemotherapy compared with 835 adverse events in the 293 patients who received just four cycles of chemotherapy. “This is an important and meaningful benefit to patients,” Poeschel added.

The researchers will continue to track the health of study participants for an additional five years to determine whether decreasing the number of chemotherapy cycles may help reduce long-term side effects of chemotherapy.

Source: ASH