Bruce D. Cheson, MD


November 25, 2013

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Expect Some 'Very Important Stuff'

Hello again. This is Bruce Cheson from Georgetown University Hospital, Lombardi Comprehensive Cancer Center, with the annual pre-ASH (American Society of Hematology) edition of Medscape Hematology.

ASH is going to have some very entertaining presentations this year, very important stuff. There will still be some lingering trials involving chemotherapy regimens, but more and more we'll be seeing new agents taking their rightful place in the management of lymphoid malignancies.

There will be some important data using CHOP or R-CHOP as the backbone for a number of studies. Lenalidomide is a drug with single-agent activity in a variety of lymphoid malignancies. There will be a follow-up of the Fondazione Italiana Linfomi (FIL) group's study[1] with lenalidomide plus R-CHOP in diffuse large B-cell lymphoma, which shows excellent response rates that are durable even in older patients with this disease. There will be the same regimen with high tumor burden follicular lymphoma.[2]

Ibrutinib is an interesting drug in diffuse large B-cell lymphoma. At last year's ASH meeting, we saw that it had a 41% single-agent response rate in the activated B-cell (ABC) subtype of diffuse large B-cell lymphoma.[3] Now we will see the results of R-CHOP with ibrutinib in this setting. These data have led to a multicenter pivotal trial of R-CHOP with or without ibrutinib in this patient population.[4]

Long-term Results in Maintenance

Maintenance just doesn't seem to go away. I'm not a big fan of it. If you've seen my videos before, you know that. But there are 2 very important maintenance studies that will be presented. The long-term follow-up of the PRIMA trial,[5] which was R-chemotherapy followed by 2 years of rituximab maintenance or observation, showed a progression-free survival advantage but not an overall survival advantage. Now we are going to see what happened 6 years later. Gilles Salles will be presenting those data.

The group that first gave us maintenance and brought it to the forefront was the Swiss group, SAKK.[6] They did the first study of 4 weekly doses of rituximab followed by 4 additional doses of maintenance or not. They are going to be presenting an important trial because we don't know the optimal duration of maintenance. Others have done 2 years, 1 year, or 5 years. Now they've done a study of 2 years vs 5 years of rituximab maintenance. I was just with Michele Ghielmini in Japan a week or so ago, and he told me the results. You'll find them very interesting, but I can't tell you what they are. You'll have to see them at ASH.


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