Anthracycline ageism.

Looking for a tolerable treatment for your patient with diffuse large B-cell lymphoma (DLBCL) who is well-endowed in both age and ECOG numbers? We’ve got you covered with a new validated chemo-combo, and it’s anthracycline free. A Chinese phase 2 trial assessed rituximab/ gemcitabine/ oxaliplatin (R-GemOx) x 6 for patients age ≥60 with newly-diagnosed DLBCL, and 28/60 (47%) patients achieved a complete response. Rates of progression-free (PFS) and overall survival (OS) at 3 years were an impressive 49% and 65%, holding steady even among the 16 patients age ≥80. Most impressive of all? The single-digit rates of ≥grade 3 toxicity. Comparatively, R-CHOP for patients age 60-80 with ECOG 0-1 on RICOVER-60 resulted in similar PFS (53%) and better OS (78%) at 3 years. But that’s with over a quarter of these patients being ≥80 years and almost half with an ECOG status ≥2. Not to mention R-GemOx comes without the 9% risk of treatment-related deaths. TBL: If you’re worried your elderly frail patient with DLBCL can’t tolerate R-CHOP, R-GemOx isn’t a bad alternative. | Shen, Lancet Haematol 2018