Raadpleeg ook literatuurlijsten niet-toxische behandelingen en middelen specifiek bij lymfklierkanker van arts-bioloog drs. Engelbert Valstar. Want indolente lymfklierkanker is ook goed onder controle te houden met voeding en leefstijl. 

Zie ook in gerelateerde artikelen meer over vormen van immuuntherapie bij lymfklierkanker

31 maart 2019: Bron: Journal of Clinical Oncology

Wanneer bij patienten met een recidief / progressie van indolente lymfklierkanker (laaggradig) lenalidomide wordt toegevoegd aan rituximab dan stijgt de mediane progressievrije overleving met meer dan 2 jaar in vergelijking met alleen rituximab plus placebo. De mediane progressievrije ziekte ging van 14,1 maanden naar 39,4 procent, daarbij aangetekend dat voor de combinatiegroep het laatste eindpunt nog niet is bereikt tijdens opmaking van de resultaten want nog verschillende patienten hadden nog steeds bij opmaken van de resultaten geen recidief of progressie van hun ziekte. Dus dat kan alleen nog maar beter worden. Wel erbij aangetekend dat de bijwerkingen in de combinatiegroep wel erger waren maar waren wel goed te controleren. Aldus de onderzoekers.

Progression-free survival was significantly improved for lenalidomide plus rituximab versus placebo plus rituximab, with a hazard ratio of 0.46 (95% CI, 0.34 to 0.62; P < .001) and median duration of 39.4 months (95% CI, 22.9 months to not reached) versus 14.1 months (95% CI, 11.4 to 16.7 months), respectively.

Deze resultaten komen uit een fase III studie bij totaal 358 patiënten die gerandomiseerd waren ingedeeld in een groep die lenalidomide plus rituximab kreeg toegediend (n = 178) of een placebo plus rituximab (n = 180).

Uit de conclusie:

The AUGMENT study met its primary end point; lenalidomide plus rituximab demonstrated statistically significant and clinically relevant superiority in PFS over placebo plus rituximab in patients with relapsed or refractory indolent FL/MZL who are considered appropriate for rituximab monotherapy. Lenalidomide plus rituximab, administered over 1 year, reduced risk of progression by 54% (HR, 0.46; 95% CI, 0.34 to 0.62; P < .001) and increased median PFS by more than 2 years compared with rituximab monotherapy

Figure

Omdat het volledige studierapport: AUGMENT: A Phase III Study of Lenalidomide Plus Rituximab Versus Placebo Plus Rituximab in Relapsed or Refractory Indolent Lymphoma gratis is in te zien beperk ik de informatie met het abstract en referentielijst:

Lenalidomide improved efficacy of rituximab in patients with recurrent indolent lymphoma, with an acceptable safety profile.

AUGMENT: A Phase III Study of Lenalidomide Plus Rituximab Versus Placebo Plus Rituximab in Relapsed or Refractory Indolent Lymphoma

, MD1 ; , MD2 ; , MD3 ; , MD4 ; , MD5 ; , PhD6 ; ..., MD7 ; , MD, PhD8 ; , MD9 ; , MD10
x
Grzegorz S. Nowakowski
; , MD11 ; , MD12 ; , MD, PhD13
x
Laura Maria Fogliatto
; , MD14 ; , MD, PhD15 ; , MD16 ; , MD17 ; , MD, PhD18 ; , MD18 ; , PhD19 ; , PhD18 ; and , MD, DSc20 ; 1Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
2Charles University, General Hospital, Prague, Czech Republic
3National Cancer Center Hospital, Tokyo, Japan
4The University of Texas MD Anderson Cancer Center, Houston, TX
5Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
6Peking University Cancer Hospital and Institute, Beijing, People’s Republic of China
7Tianjin Medical University Cancer Institute and Hospital, Tianjin, People’s Republic of China
8Ghent University Hospital, Gent, Belgium
9Instituto Nacional de Câncer, Rio de Janeiro, Brazil
10Mayo Clinic, Rochester, MN
11Istituto Nazionale Tumori IRCCS - Fondazione Pascale, Naples, Italy
12Azienda Ospedaliero Universitaria di Parma, Parma, Italy
13Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
14Hospital A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
15Sarah Cannon Research Institute, Nashville, TN
16Instituto Português de Oncologia do Porto Francisco Gentil Epe, Porto, Portugal
17Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
18Celgene Corporation, Summit, NJ
19Celgene International, Boudry, Switzerland
20Barts Cancer Institute, London, United Kingdom
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Creative Commons Attribution Non-Commercial No Derivatives 4.0 License: https://creativecommons.org/licenses/by-nc-nd/4.0/

Patients with indolent non-Hodgkin lymphoma typically respond well to first-line immunochemotherapy. At relapse, single-agent rituximab is commonly administered. Data suggest the immunomodulatory agent lenalidomide could increase the activity of rituximab.

A phase III, multicenter, randomized trial of lenalidomide plus rituximab versus placebo plus rituximab was conducted in patients with relapsed and/or refractory follicular or marginal zone lymphoma. Patients received lenalidomide or placebo for 12 cycles plus rituximab once per week for 4 weeks in cycle 1 and day 1 of cycles 2 through 5. The primary end point was progression-free survival per independent radiology review.

A total of 358 patients were randomly assigned to lenalidomide plus rituximab (n = 178) or placebo plus rituximab (n = 180). Infections (63% v 49%), neutropenia (58% v 23%), and cutaneous reactions (32% v 12%) were more common with lenalidomide plus rituximab. Grade 3 or 4 neutropenia (50% v 13%) and leukopenia (7% v 2%) were higher with lenalidomide plus rituximab; no other grade 3 or 4 adverse event differed by 5% or more between groups. Progression-free survival was significantly improved for lenalidomide plus rituximab versus placebo plus rituximab, with a hazard ratio of 0.46 (95% CI, 0.34 to 0.62; P < .001) and median duration of 39.4 months (95% CI, 22.9 months to not reached) versus 14.1 months (95% CI, 11.4 to 16.7 months), respectively.

Lenalidomide improved efficacy of rituximab in patients with recurrent indolent lymphoma, with an acceptable safety profile.

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