Cancer Conference Update: A Multimedia Review of Key Presentations from the 2016 American Society of Hematology Annual MeetingAbstract 145: Final results of the Phase III LyMa study of rituximab maintenance after ASCT in younger patients with mantle cell lymphoma
4:58 minutes.
TRANSCRIPTION:
DR FLOWERS: So mantle cell lymphoma, when we look at this disease entity, we typically think of it in 2 separate patient populations, at least — the elderly patient population where the approach to therapy typically is with less intensive therapy followed by some period of observation. We now know from data from the German group that in the randomized setting of giving rituximab maintenance following BR for those patients that there’s no clear benefit to giving rituximab maintenance. When you look at the other population of mantle cell patients, there is a population that we have more aggressive-behaving disease or who are younger, where we consider autologous stem cell transplantation. I think there are 2 particularly interesting things about this trial. One is the choice of induction regimen that was selected for this trial design. We know from a number of different trials, from the MD Anderson trials on R-hyper-CVAD and from the Nordic trials and from a number of other trials that there is a benefit to giving cytarabine or ara-C for patients with mantle cell lymphoma. In this trial, they used the R-DAP chemotherapy regimen as their front-line chemotherapy regimen for patients with mantle cell lymphoma. So there was really no planned anthracycline for the majority of patients. We now have data from a randomized trial that the combination of R-CHOP/R-DAP was better than R-CHOP as an induction regimen. This trial takes that 1 step further and attempts to drop the R-CHOP from the regimen. There are really 2 secrets to that. One is that the way R-DAP was written into this trial is that patients were planned to have cisplatin as their form of platinum therapy. But it allowed investigators or centers to choose either on a patient-by-patient basis or on a center basis whether or not to give that or to give either oxaliplatin or carboplatin. And there was a substantial fraction of patients who actually got carboplatin as their form of platinum therapy. So I think when looking at these results, that’s something that needs to be born in mind, because there’s substantially less toxicity seen in terms of nephrotoxicity than what you might expect for an R-DAP chemotherapy regimen. The other thing that I think is important is that patients who were not able to achieve a CR or PR with their R-DAP therapy, they did to on to R-CHOP-14 before stem cell transplant. So it does leave the out of giving an anthracycline as a regimen. And so that’s an important distinction to make about this up-front regimen. The other thing, though, that I think is the key point is the way that the trial was designed, is, this was a trial that was more than 290 patients who were randomized to receive rituximab maintenance versus no maintenance. And when you look at the benefits of this trial, there was a benefit both in terms of progression-free survival and a benefit in terms of overall survival, with a 4-year progression-free survival of 68% and a 4-year overall survival of 78% in this population, so benefits in terms of progression-free survival and overall survival to giving rituximab maintenance after chemotherapy induction for patients with mantle cell lymphoma who got a transplant. DR LOVE: I mean, it’s substantial, I mean, 50% to 60% reduction. DR FLOWERS: Now, these are impressive results. Again, we need to see the final publication before moving forward, but this is the kind of result that could change the standard of care for patients with mantle cell lymphoma. DR LOVE: Now, they say this is the first time this has been demonstrated, but wasn’t there a previous trial that looked at R maintenance after transplant? DR FLOWERS: So there are other trials that have looked at R maintenance after transplant. The best of those is a little bit of a complex trial that looked at R maintenance as a way of eradicating minimal residual disease and followed patients with minimal residual disease, continuing to give R maintenance to be able to eradicate minimal residual disease. This simplifies that approach and gives kind of a commonplace approach that doctors out in the community can use that, after an autologous stem cell transplant there is a benefit to R maintenance both in terms of progression-free survival and overall survival. And if these results are ultimately published, it’s the kind of approach that, gosh, should be used to provide that benefit to patients who go through allotransplant. |