TY - JOUR
T1 - Addition of Lenalidomide to R-CHOP Improves Outcomes in Newly Diagnosed Diffuse Large B-Cell Lymphoma in a Randomized Phase II US Intergroup Study ECOG-ACRIN E1412
AU - Nowakowski, Grzegorz S.
AU - Hong, Fangxin
AU - Scott, David W.
AU - Macon, William R.
AU - King, Rebecca L.
AU - Habermann, Thomas M.
AU - Wagner-Johnston, Nina
AU - Casulo, Carla
AU - Wade, James L.
AU - Nagargoje, Gauri G.
AU - Reynolds, C. M.
AU - Cohen, Jonathon B.
AU - Khan, Nadia
AU - Amengual, Jennifer E.
AU - Richards, Kristy L.
AU - Little, R. F.
AU - Leonard, John P.
AU - Friedberg, Jonathan W.
AU - Kostakoglu, Lale
AU - Kahl, Brad S.
AU - Witzig, Thomas E.
N1 - Funding Information:
This study was coordinated by the ECOG-ACRIN Cancer Research Group (Peter J. O’Dwyer, MD, and Mitchell D. Schnall, MD, PhD, Group CoChairs) and supported by the National Cancer Institute of the National Institutes of Health under the following award numbers: U10CA180820, U10CA180794, UG1CA232760, UG1CA233230, UG1CA233339, UG1CA233196, U10CA180821,UG1CA233277, UG1CA233247, U10CA180888, UG1CA189830, UG1CA189863, and UG1CA189971.
Publisher Copyright:
© 2021 by American Society of Clinical Oncology Creative Commons Attribution Non-Commercial No Derivatives 4.0 License
PY - 2021/4/20
Y1 - 2021/4/20
N2 - PURPOSE Lenalidomide combined with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) (R2CHOP) in untreated diffuse large B-cell lymphoma (DLBCL) has shown promising activity, particularly in the activated B-cell–like (ABC) subtype. Eastern Cooperative Oncology Group (ECOG)ACRIN trial E1412 was a randomized phase II study comparing R2CHOP versus R-CHOP in untreated DLBCL. PATIENTS AND METHODS Patients with newly diagnosed DLBCL, stage II bulky-IV disease, International Prognostic Index (IPI) $ 2, and ECOG performance status # 2 were eligible and randomly assigned 1:1 to R2CHOP versus R-CHOP for six cycles. Tumors were analyzed using the NanoString Lymph2Cx for cell of origin. The primary end point was progression-free survival (PFS) in all patients with the co-primary end point of PFS in ABC-DLBCL. Secondary end points included overall response rate (ORR), complete response (CR) rate, and overall survival (OS). RESULTS Three hundred forty-nine patients were enrolled; 280 patients (145 R2CHOP and 135 R-CHOP) were evaluable: 94 were ABC-DLBCL, 122 germinal center B-cell–like-DLBCL, 18 unclassifiable, and 46 unknowns. Baseline characteristics were well-balanced between arms, and the median age was 66 (range, 24-92); 70% of patients had stage IV disease; 34%, 43%, and 24% had IPI 2, 3, and 4 or 5, respectively. Myelosuppression was more common in the R2CHOP arm. The ORR and CR rate were 92% and 68% in R-CHOP and 97% (P 5 .06) and 73% (P 5 .43) in the R2CHOP arm, respectively. The median follow-up was 3.0 years; R2CHOP was associated with a 34% reduction in risk of progression or death versus R-CHOP (hazard ratio [HR], 0.66 95% CI, 0.43 to 1.01) and 3-year PFS of 73% versus 61%, one-sided P 5 .03, and an improvement in OS (83% and 75% at 3 years; HR, 0.67; one-sided P 5 .05). The PFS HR for R2CHOP was 0.67 for ABC-DLBCL, one-sided P 5 .1. CONCLUSION In this signal-seeking study, the addition of lenalidomide to R-CHOP (R2CHOP) improved outcomes in newly diagnosed DLBCL including patients with ABC-DLBCL.
AB - PURPOSE Lenalidomide combined with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) (R2CHOP) in untreated diffuse large B-cell lymphoma (DLBCL) has shown promising activity, particularly in the activated B-cell–like (ABC) subtype. Eastern Cooperative Oncology Group (ECOG)ACRIN trial E1412 was a randomized phase II study comparing R2CHOP versus R-CHOP in untreated DLBCL. PATIENTS AND METHODS Patients with newly diagnosed DLBCL, stage II bulky-IV disease, International Prognostic Index (IPI) $ 2, and ECOG performance status # 2 were eligible and randomly assigned 1:1 to R2CHOP versus R-CHOP for six cycles. Tumors were analyzed using the NanoString Lymph2Cx for cell of origin. The primary end point was progression-free survival (PFS) in all patients with the co-primary end point of PFS in ABC-DLBCL. Secondary end points included overall response rate (ORR), complete response (CR) rate, and overall survival (OS). RESULTS Three hundred forty-nine patients were enrolled; 280 patients (145 R2CHOP and 135 R-CHOP) were evaluable: 94 were ABC-DLBCL, 122 germinal center B-cell–like-DLBCL, 18 unclassifiable, and 46 unknowns. Baseline characteristics were well-balanced between arms, and the median age was 66 (range, 24-92); 70% of patients had stage IV disease; 34%, 43%, and 24% had IPI 2, 3, and 4 or 5, respectively. Myelosuppression was more common in the R2CHOP arm. The ORR and CR rate were 92% and 68% in R-CHOP and 97% (P 5 .06) and 73% (P 5 .43) in the R2CHOP arm, respectively. The median follow-up was 3.0 years; R2CHOP was associated with a 34% reduction in risk of progression or death versus R-CHOP (hazard ratio [HR], 0.66 95% CI, 0.43 to 1.01) and 3-year PFS of 73% versus 61%, one-sided P 5 .03, and an improvement in OS (83% and 75% at 3 years; HR, 0.67; one-sided P 5 .05). The PFS HR for R2CHOP was 0.67 for ABC-DLBCL, one-sided P 5 .1. CONCLUSION In this signal-seeking study, the addition of lenalidomide to R-CHOP (R2CHOP) improved outcomes in newly diagnosed DLBCL including patients with ABC-DLBCL.
UR - http://www.scopus.com/inward/record.url?scp=85102964171&partnerID=8YFLogxK
U2 - 10.1200/JCO.20.01375
DO - 10.1200/JCO.20.01375
M3 - Article
C2 - 33555941
AN - SCOPUS:85102964171
SN - 0732-183X
VL - 39
SP - 1329
EP - 1338
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 12
ER -