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Blood Cancers Video Library: What Therapy Should We Use for DLBCL in 2016?

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GRACE joined a number of top faculty in the area of hematology in Whistler BC, for the 3rd Annual Summit on Hematologic Malignancies.  Wyndham Wilson, MD, PhD, Senior Scientist at NIH, Director Lymphoid Tumor Group, Senior Investigator Lymphoid Malignancies Branch of the National Cancer Institute discusses what types of therapies should we be using in 2016, including R-CHOP as a standard of care for most large cell lymphomas, and a regimen called Dose Adjusted EPOCH-R which appears to have been a major advance over the use of standard therapy with R-CHOP.

 

 

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Chronic Lymphocytic Leukemia

and Non-Hodgkin Lymphoma

What Therapy Should We Use for DLBCL in 2016?

Wyndham Wilson, MD, PhD

Senior Scientist at NIH, Director Lymphoid Tumor Group

Senior Investigator, Lymphoid Malignancies Branch of the National Cancer Institute

 

Let me just talk about what types of therapies should we be using in 2016. I think that we are still using R-CHOP as standard of care for most large cell lymphomas. There is a particular type of large cell lymphoma that does occur in younger patients, and it actually occurs somewhat more commonly in women, and that’s called primary mediastinal large cell lymphoma. A study was recently published approximately one to two years ago that actually showed that a regimen called Dose Adjusted EPOCH-R had a cure rate of approximately 90 percent. This appears to have been a major advance over the use of standard therapy with R-CHOP, because the cure rate with R-CHOP or R-CHOP-like regimens alone is more in the 50 to 60 percent range.

When you give R-CHOP chemotherapy for primary mediastinal, it is usually given along with radiotherapy. Although the cure rates with R-CHOP and radiotherapy appear to be similar to that of Dose Adjusted EPOCH-R alone, having radiotherapy, especially in people that are relatively young, where the median age is 30 years old, leads to long-term side effects such that the chance of getting secondary cancers or heart disease 20 to 30 years after getting radiotherapy can be as high as 25 to 40 percent. So whatever we can do to attempt to cure these younger folks without using radiotherapy I think will be a major advance. The Dose Adjusted EPOCH-R regimen at the current time seems to have the highest cure rate and does not usually require radiotherapy.

We’re still using R-CHOP as standard of care for the GCB and the ABC large cell types. As I mentioned, the PHOENIX trial has been completed, where we’ve tested whether or not the protein kinase inhibitor ibrutinib may improve the cure rate of ABC, and hopefully we will know the answer to that trial within the next several years.

There is also a large randomized study that was finished last year that compared the standard R-CHOP to the Dose Adjusted EPOCH-R regimen, and that trial will be reading out sometime this year. The hypothesis from that trial is that the Dose Adjusted EPOCH-R regimen may be more effective than standard R-CHOP in both the ABC as well as the GCB type of large cell. However, until those two trials are actually read out, I think it is fair to say, at least for ABC and GCB, that the standard of care remains R-CHOP therapy.


 

 

 


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