Bruce D. Cheson, MD


May 23, 2012

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Welcome to another episode of Medscape Hematology. I'm Bruce Cheson from Georgetown University Hospital, the Lombardi Cancer Center. It's that time again. We are 2 weeks and a couple of days away from the American Society of Clinical Oncology (ASCO®) Annual Meeting, and heaven forbid they should let us see the abstracts at this point in time. The program was just released, and I am going to present what I think will be some interesting studies. Hopefully they will be of interest to you as they probably will be to me.

Several studies are focusing on identifying the best initial therapy for patients with follicular lymphoma. The Italians are updating their data on R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) vs R-CVP (rituximab, cyclophosphamide, vincristine, and prednisone) vs R-FM (rituximab, fludarabine, and mitoxantrone).[1] I'm not sure how important this is because we are starting to move away from at least 2 or maybe all 3 of these regimens.

The second study, which is of more interest and controversy, is an update of the Southwest Oncology Group's (SWOG) intergroup comparison of R-CHOP vs CHOP followed by I-131-tositumomab (Bexxar™).[2] When Oliver Press presented these data at the American Society of Hematology meeting, no difference was found between the 2 arms in the major endpoints. We asked about prognostic groups such as the Follicular Lymphoma International Prognostic Index (FLIPI), and that is what will be presented at the ASCO® meeting.

The Eastern Cooperative Oncology Group (ECOG) led the important RESORT trial, which was a study of 4 weekly doses of rituximab followed by indefinite maintenance vs 4 weekly doses, observation, and re-treatment upon progression.[3] The presentation at ASCO® will be a subset analysis of patients with underinvestigated histologic subtypes -- namely, small lymphocytic lymphoma and marginal zone lymphoma. We will see whether the different strategies impact the outcome of those patient groups.

We saw it in 2007, we saw it again in 2009, and now we are seeing it in the plenary session: the update of the R-CHOP vs R-bendamustine study from the StiL (Study Group of Indolent Lymphomas) trial[4] -- frontline therapy for follicular, mantle cell, lymphoplasmacytic, and marginal zone lymphomas all lumped together, where R-bendamustine [in the previous presentations] was more effective and less toxic. We will see longer follow-up, but rather than abstract after abstract, it would be nice to finally see a published manuscript.

In the relapse setting for follicular lymphoma, John Leonard is going to be presenting the CALGB comparison of lenalidomide vs lenalidomide plus rituximab.[5] This second regimen, affectionately known as "R squared," has become the basis for a number of relapses and now frontline studies. Therefore, these data are important and will be of interest.

Looking at aggressive lymphomas, the German High Grade Non-Hodgkin's Lymphoma Study Group is going to be presenting their results from an allogeneic stem cell transplant prospective study in patients with refractory high-grade lymphoma.[6] Is this a useful therapy? We will find out in a couple of weeks.

In Hodgkin lymphoma studies, there is yet another comparison of ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) vs escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone), this time from the European Organization for Research and Treatment of Cancer (EORTC).[7] We have seen it before, and the results suggested more toxicity from the escalated BEACOPP but a longer time-to-treatment failure, with maybe some advantage of short-term survival. We will see what the EORTC comes up with.

Those are most of the lymphoma studies. Myeloma is focusing in large part on new agents. Finally, there are new agents for myeloma. There is a series of abstracts, including all you ever wanted to know about carfilzomib, the new novel proteasome inhibitor, which is now included in various combinations with other agents.

There are a number of other abstracts discussing newer agents such as the histone deacetylase (HDAC) inhibitor panobinostat, the apoptosis-inducing drug obatoclax, bendamustine, pomalidomide, and the other proteasome inhibitor, MLN9708. We need new drugs in myeloma, and hopefully these will in some combination present some promise.

That is what we have to look forward to at ASCO®. There is one oral lymphoma session, one oral myeloma session, and one paper at the plenary session. There should be interesting data that will hopefully impact the treatment of our patients and novel therapies that may prolong their survival.

This is Bruce Cheson signing off for Medscape Hematology. I look forward to seeing you at ASCO®. Goodbye.


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