Lymphoma in elderly patients is particularly difficult to treat because of their reduced ability to tolerate chemotherapy. But a large phase 2 trial, published in The Lancet Oncology, reports that a modified treatment approach using a decreased dose of conventional chemotherapy combined with a standard dose of rituximab was well tolerated and yielded a substantial response and improved survival in very elderly patients with diffuse large B-cell lymphoma, a common and very aggressive form of non-hodgkin's lymphoma.

These findings suggest for the first time that a large proportion of patients older than 80 years with diffuse large B-cell lymphoma can be cured, and that this new regimen should become the standard treatment in these patients.

Diffuse B-cell lymphoma is a common cancer in the elderly, and with the increase in life expectancy of the general population, cases are set to rise. Over the past decade, combining the monoclonal antibody rituximab with the standard chemotherapy regimen CHOP (doxorubicin, cyclophosphamide, vincristine, and prednisone) has significantly improved survival in patients younger than 80 years. However, trials have not included patients over 80 years. A small retrospective study suggested that in patients older than 80 years a reduced-dose standard chemotherapy regimen might increase tolerability while maintaining efficacy.

In this study, a team led by Frédéric Peyrade from Onco-Hematology Centre regional de Lutte contre le cancer de Nice, Nice, France investigated the efficacy and safety of the combination of a low-dose of CHOP chemotherapy with a standard dose of rituximab R-miniCHOP) in patients over 80 years with diffuse B-cell lymphoma. Between 2006 and 2009, 150 patients were enrolled from 38 centres across France and Belgium and given six cycles of R-miniCHOP at 3 week intervals.

Overall response rates achieved were 73%, and the complete or unconfirmed complete response rate was 62%.

With a median follow-up of 20 months, median overall survival was 29 months and the 2-year overall survival rate was 59%.

The R-miniCHOP regimen was well tolerated, allowing administration of the full planned dose in 72% of the patients. A very low number of hospital admissions and a low number of deaths (12) were attributed to treatment toxicity.

The authors conclude: "R-miniCHOP offers a good compromise between efficacy and safety...and should be the standard treatment for patients older than 80 years who have diffuse large B-cell lymphoma and a good performance status".

Commenting on the study, Josep-Maria Ribera from Institut de Recerca Contra la Leucèmia Josep Carreras, Universitat Autònoma de Barcelona, Spain said: "These results...provide hope for very elderly patients with diffuse large B-cell lymphoma—a group that is frequently excluded from clinical trials."

Dr Ribera adds: "The most important issues for the near future are how to extend these benefits to a broader spectrum of patients and how to further increase the effectiveness of this treatment regimen."


Source: Lancet Oncology

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