By Will Boggs MD
NEW YORK (Reuters Health) - 15/3/2019
The combination of bendamustine and rituximab provides better progression-free survival (PFS), event-free survival, and duration of response in patients with indolent non-Hodgkin lymphoma and mantle-cell lymphoma, compared with other regimens, according to five-year results from the BRIGHT follow-up study.
Earlier, the trial found bendamustine-rituximab (BR) to be noninferior to either rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or rituximab plus cyclophosphamide, vincristine, and prednisone (R-CVP) for treatment-naive patients with indolent non-Hodgkin lymphoma (iNHL) or mantle-cell lymphoma (MCL).
Dr. Ian W. Flinn from Sarah Cannon Research Institute/Tennessee Oncology, in Nashville, and colleagues now report long-term follow-up data for the BRIGHT study.
Overall PFS rates at five years after random assignment were significantly higher in the BR treatment group (65.5%) than in the R-CHOP/R-CVP group (55.8%), the team reports in the Journal of Clinical Oncology, online February 27.
The treatment benefit of BR was evident in both patients with iNHL and those with MCL.
Overall survival at five years was similar in the BR (81.7%) and R-CHOP/R-CVP (85.0%) groups, with no significant difference in overall survival by lymphoma type.
Evaluations of event-free survival and duration of response also significantly favored BR over the other treatments.
Significantly fewer patients in the BR group (26%) than in the R-CHOP/R-CVP group (39%) required second-line treatment during the follow-up period, according to an ad hoc analysis.
Safety assessments of the regimens have not changed from those first published. BR was associated with a significantly higher incidence of secondary malignancy compared to the other treatments, particularly in the incidence of squamous and basal cell carcinoma of the skin, the researchers say.
"Overall, BR demonstrated better long-term disease control than R-CHOP/R-CVP and should be considered as a first-line treatment option for patients with indolent and mantle-cell lymphoma," the researchers conclude.
Dr. Peter Martin from Weill Cornell Medicine, in New York City, who has studied various aspects of iNHL and MCL, told Reuters Health by email, "For the most part, these results are consistent with data from the STiL trial, and not so much surprising as encouraging to those of us that believe that there are multiple reasonable treatment options for people with iNHL and MCL, each with various pros and cons."
"If there is anything curious in the data," he said, "it is related to the following observations: 1) The impact of BR appears to be more significant in MCL than in follicular lymphoma. Why? 2) The difference in infectious and cardiac deaths as well as the difference in second cancers begs further study. Any of us with some knowledge of chemotherapy and a creative imagination can come up with hypotheses, but at this point I'm not convinced that the observation has a significant impact on individual patients."
"I will continue to carefully evaluate each individual patient," said Dr. Martin, who was not involved in the study. "What makes them unique? What are their goals? What are they willing to put up with? Is there anything about the lymphoma that is different? I think that there is still a role for shared physician/patient decision making in these lymphomas-there is no cookbook for lymphoma therapy just yet."
Teva Pharmaceuticals provided support for the study and employed two of the authors.
Dr. Flinn did not respond to a request for comments.
J Clin Oncol 2019.