Rituximab Shows Long-Term Benefits in Follicular Lymphoma
METHODOLOGY:
Researchers conducted an open-label, randomised, phase 3 trial in which 455 patients with asymptomatic, stage II-IV, grade 1-3a low tumour burden follicular lymphoma were randomly assigned in a 1:1:1 ratio to the watchful waiting (n = 183), rituximab induction (n = 82), or rituximab maintenance (n = 190) group.
Rituximab induction comprised 375 mg/m 2 intravenous doses weekly for 4 weeks, and the rituximab maintenance group received additional 12 doses every 8 weeks at the same dose.
intravenous doses weekly for 4 weeks, and the rituximab maintenance group received additional 12 doses every 8 weeks at the same dose. The primary endpoint was the time to initiation of new treatment (TTNT), defined as the time from randomisation until the first day of systemic chemotherapy or radiotherapy initiation.
This study reported long-term results of the trial over a median follow-up duration of 14.7 years.
TAKEAWAY:
At 15 years, 65% (95% CI, 56-72) of patients in the rituximab maintenance group, 48% (95% CI, 36-60) of patients in the rituximab induction group, and 34% (95% CI, 27-42) of patients in the watchful waiting group had not started new treatment.
The median TTNT was 5.6 years (95% CI, 3.8-8.4) in the watchful waiting group, 14.8 years (95% CI, 7.5 to not reached) in the rituximab induction group, and not reached (95% CI, 15.6 to not estimable) in the rituximab maintenance group.
The TTNT was significantly longer for patients in both rituximab groups than for those in the watchful waiting group (rituximab induction vs watchful waiting: hazard ratio [HR], 0.55; 95% CI, 0.38-0.80; P = .0019; rituximab maintenance vs watchful waiting: HR, 0.36; 95% CI, 0.26-0.50; P < .0001).
= .0019; rituximab maintenance vs watchful waiting: HR, 0.36; 95% CI, 0.26-0.50; < .0001). No significant differences in overall survival were observed between the groups at 15 years (rituximab maintenance, 73%; rituximab induction, 66%; and watchful waiting, 68%).
Similarly, no significant differences in the risk for high-grade transformation and the time to initiation of second new treatment were observed between the groups.
IN PRACTICE:
"Early rituximab monotherapy could therefore be considered a standard treatment option for patients with advanced stage, asymptomatic low tumour burden follicular lymphoma and the optimal approach should be considered on an individual patient basis," the authors concluded.
SOURCE:
This study was led by Michael Northend, University College London Hospitals NHS Foundation Trust, London, England. It was published online in The Lancet Haematology .
LIMITATIONS:
This study was limited by the lack of long-term toxicity data, especially for patients receiving rituximab maintenance, and the early closure of the rituximab induction group, which limited the power of any comparisons with the four-dose rituximab induction regimen.
DISCLOSURES:
This study received funding from Cancer Research UK, the Lymphoma Research Trust, Lymphoma Action, and Roche. Roche provided rituximab free of charge. Additional disclosures are noted in the original article. Several authors reported receiving honoraria and consultancy fees and having other ties with various sources.
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