Bruce D. Cheson, MD; Gilles Salles, MD, PhD


December 16, 2013

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Bruce D. Cheson, MD: Hello. I am Bruce Cheson, Deputy Chief of Hematology-Oncology and Head of Hematology at Georgetown University Hospital and the Lombardi Comprehensive Cancer Center in Washington, DC. Welcome to this edition of Medscape Oncology Insights. Today we are going to look at several key studies in the lymphoma portfolio presented at the 55th annual meeting of the American Society of Hematology (ASH), taking place here in New Orleans. Joining me is my friend Gilles Salles, Professor of Medicine in the Department of Hematology at the Université Claude Bernard, Hospices Civils de Lyon, France.

Gilles Salles, MD, PhD: Hello, Bruce.

R-CHOP Gets Reinforcements in DLBCL

Dr. Cheson: We are in the second year of a trend at ASH. Last year, new agents and new concepts took over, and this year I am glad to see that the trend has continued across histologies. We have some interesting data in large cell, follicular and mantel cell, and even in Waldenström disease. It is very exciting. We have also seen in several diseases how things we are learning in the laboratory are making advances in the clinic. Could you tell us what excited you in the large cell arena?

Dr. Salles: In the large cell arena, we have seen a couple of studies combining new agents with classic regimens. Among these new agents that target potentially discrete forms of diffuse large B-cell lymphoma (DLBCL) are ibrutinib and lenalidomide.

Two studies were presented providing results of the combination of each of these drugs with the classic R-CHOP [rituximab, cyclophosphamide, hydroxydaunorubicin, Oncovin (vincristine), prednisone]. One is a phase 1b study[1] combining ibrutinib plus R-CHOP, and it shows that it is feasible to combine this very active drug -- which as a single agent is already active in the subset of patients with so-called non-germinal center B (GCB) diffuse large B-cell lymphoma -- with R-CHOP, and this combination provides a very high response rate (100%). It is too early to discriminate partial response and complete response, but at least it shows the feasibility of combining this very promising drug with R-CHOP.

The second one is an Italian study[2] that evaluated the combination of lenalidomide and R-CHOP, which showed that it was again feasible to combine this drug for a couple of days with R-CHOP. They evaluated this combination in 80 patients and showed that in this cohort of patients, there was no significant difference in prognosis in the non-GCB subtype of patients. Usually the non-GCB patients don't do as well with R-CHOP, so it seems that the addition of lenalidomide may potentially reverse the adverse prognosis for this subset of patients. These are quite encouraging results. In this field, large phase 3 studies are being developed and are currently accruing patients to evaluate in more detail the potential of this drug in combination with R-CHOP in DLBCL.

Dr. Cheson: We are from an era when there was a misconception that more treatment is better treatment. CHOP-21, augmented CHOP, mega-CHOEP, and so on, were all developed. Now we have gone back to R-CHOP and started adding [targeted] drugs in pill form that will hopefully improve outcome. Maybe someday we will be able to dissect some of the chemotherapy drugs from R-CHOP and get rid of them. That would be pretty good. It is exciting. The trial you mentioned, the PHOENIX trial, is ongoing,[3] which is R-CHOP with or without ibrutinib in the non-GCB subtype patient.

What excited you in follicular this year?


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