Hit em’ hard, hit em’ early.
Top Line: The addition of chemoimmunotherapy to radiation therapy is something we like to call the full gamut. So let’s see how it fares for something as indolent as early stage, low grade follicular lymphoma.
The Study: Radiation is the preferred treatment for this entity. But because patients live a long time after treatment, long-term disease control isn’t that great. Progression free survival is typically in the 40-50% range 10+ years out. TROG 99.03 randomized these patients to involved field radiation (IFRT)—not the current standard of involved site—of 30 Gy +/- cyclophosphamide/ vincristine/ prednisone (CVP) x 6, with the fourth addition of rituximab after 2006. This was a relatively large study (n=150) compared to prior prospective trials, and 75% had stage I disease. In line with smaller studies, the addition of chemoimmunotherapy to radiation improved long-term progression free survival from around 40 → 60%. Unfortunately, there was no effect on overall survival. The problem here is that follicular lymphoma is in many ways a chronic disease, and it’s hard to say whether more intensive treatment upfront is any better than treatment at progression. Especially when that progression could be a decade down the road.
Bottom Line: Adding R-CVP to IFRT for early stage, low grade follicular lymphoma improves PFS at 10 years. | MacManus, J Clin Oncol 2018
The Study: Radiation is the preferred treatment for this entity. But because patients live a long time after treatment, long-term disease control isn’t that great. Progression free survival is typically in the 40-50% range 10+ years out. TROG 99.03 randomized these patients to involved field radiation (IFRT)—not the current standard of involved site—of 30 Gy +/- cyclophosphamide/ vincristine/ prednisone (CVP) x 6, with the fourth addition of rituximab after 2006. This was a relatively large study (n=150) compared to prior prospective trials, and 75% had stage I disease. In line with smaller studies, the addition of chemoimmunotherapy to radiation improved long-term progression free survival from around 40 → 60%. Unfortunately, there was no effect on overall survival. The problem here is that follicular lymphoma is in many ways a chronic disease, and it’s hard to say whether more intensive treatment upfront is any better than treatment at progression. Especially when that progression could be a decade down the road.
Bottom Line: Adding R-CVP to IFRT for early stage, low grade follicular lymphoma improves PFS at 10 years. | MacManus, J Clin Oncol 2018
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