Rituximab - Mabthera toegevoegd aan R-CHOP versus R-CVP behandeling bij lymfklierkanker - follicular lymphoma blijkt effectieve aanpak

31 maart 2019: zie ook dit artikel:

https://kanker-actueel.nl/lenalidomide-naast-rituximab-verbetert-mediane-progressievrije-overleving-met-25-maanden-39-vs-14-maanden-bij-patienten-met-recidief-van-indolente-lymfomen-lymfklierkanker-in-vergelijking-met-alleen-rituximab.html

17 april 2009: Bron:1: J Hematol Oncol. 2009 Mar 24;2(1):14. [Epub ahead of print]

In deze overzichtstudie worden de resultaten vergeleken van twee verschillende combinaties van chemo met Rituximab - Mabthera voor lymfklierkanker (follicular lymphoma (FL). Rituximab met cyclophosphamide, vincristine en prednisone tegenover Rituximab met cyclophosphamide, doxorubicin, vincristine en prednison. Beide combinaties geven volgens de auteurs van deze overzichtstudie superieure resultaten. En zit er weinig tot geen verschil in effectiviteit tussen genoemde combinaties. Hieronder het abstract en als u hier klikt kunt u het volledig studierapport lezen van genoemde studie. Lees in deze artikelenreeks onder voeding- en voedingtoffen in alfabetische lijst ook de artikelen/abstracten van studies met positief effect van gezonde leefstjil en gevarieerd en gezond eten. Onder dit abstract staat ook overzicht van aanpak en overlevingskansen van FL in periode 1987 - 2002 waarbij de effectiviteit zienderogen omhoog gaat.

R-CHOP versus R-CVP in the treatment of follicular lymphoma: a meta-analysis and critical appraisal of current literature.

Ganguly S, Patel V.

ABSTRACT: Purpose: Both R-CHOP (rituximab with cyclophosphamide, doxorubicin, vincristine and prednisone) and R-CVP (rituximab with cyclophosphamide, vincristine and prednisone) have been used successfully in the treatment of patients with symptomatic follicular lymphoma (FL). No author has compared efficacy from both treatment modalities and attempted to evaluate the role of anthracyclines in the management of patients with FL. We conducted a meta-analysis of relevant literature comparing both treatment arms for FL with response being the final endpoint. Patients and Methods: Two analyses were conducted: The first analysis compared R-CHOP to R-CVP as frontline agents for the treatment of FL and the second analysis included both untreated and relapsed patients.

RESULTS: For both studies, R-CVP was superior to R-CHOP when evaluating for complete response (CR). Odds ratios of 2.86 with a 95% CI (1.81-4.51) in the first analysis and 1.48 with a 95% CI (.991-2.22) in the second analysis favored R-CVP over R-CHOP. However for overall response (CR+PR), R-CHOP was superior with an odds ratio of .184 with a 95% CI (0.40-0.85) and .181 with a 95% CI (.088-0.371) respectively.

CONCLUSION: Both R-CHOP and R-CVP protocols achieve excellent overall response. In patients with known cardiac history, omission of anthracyclines is reasonable and R-CVP provides a competitive CR rate. In younger patients with FL where cumulative cardio-toxicity may be of importance in the long term and in whom future stem cell transplantation is an option, again R-CVP may be a more appealing option.

PMID: 19309523 [PubMed - as supplied by publisher]

Bron: J Clin Oncol. 2006 Apr 1;24(10):1582-9.

Related Articles, Links

Improvement of overall and failure-free survival in stage IV follicular lymphoma: 25 years of treatment experience at The University of Texas M.D. Anderson Cancer Center.

Liu Q, Fayad L, Cabanillas F, Hagemeister FB, Ayers GD, Hess M, Romaguera J, Rodriguez MA, Tsimberidou AM, Verstovsek S, Younes A, Pro B, Lee MS, Ayala A, McLaughlin P.

Department of Lymphoma/Myeloma, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.

PURPOSE: Advanced-stage follicular lymphoma is considered incurable. The pace of improvements in treatment has been slow. This article analyzes five sequential cohorts of patients with stage IV follicular lymphoma treated between 1972 and 2002. METHODS: Five consecutive studies (two were randomized trials) involving 580 patients were analyzed for overall survival (OS), failure-free survival (FFS), and survival after first relapse. A proportional hazards analysis, and subset analyses using the follicular lymphoma international prognostic index (FLIPI) score were performed. Treatment regimens included: cyclophosphamide, doxorubicin, vincristine, prednisone, bleomycin (CHOP-Bleo); CHOP-Bleo followed by interferon alfa (IFN-alpha); a rotation of three regimens (alternating triple therapy), followed by IFN-alpha; fludarabine, mitoxantrone, dexamethasone (FND) followed by IFN-alpha; and FND plus delayed versus concurrent rituximab followed by IFN-alpha. RESULTS: Improvements in 5-year OS (from 64% to 95%) and FFS (from 29% to 60%) indicate steady progress, perhaps partly due to more effective salvage therapies, but the FFS data also indicate improved front-line therapies; these observations held true after controlling for differences in prognostic factors among the cohorts. The FLIPI model adds rigor to and facilitates comparisons among the different cohorts. An unexpected finding in this study was a trend toward an apparent FFS plateau. CONCLUSION: Evolving therapy, including the incorporation of biologic agents, has led to stepwise significant outcome improvements for patients with advanced-stage follicular lymphoma. The apparent plateau in the FFS curve, starting approximately 8 to 10 years from the beginning of treatment, raises the issue of the potential curability of these patients.

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