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First-Line Treatment of Indolent Non-Hodgkin Lymphoma or Mantle Cell Lymphoma With Bendamustine/Rituximab vs R-CHOP or R-CVP

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Key Points

  • Bendamustine/rituximab was associated with improved 5-year progression-free survival vs R-CHOP/R-CVP.
  • Bendamustine/rituximab was associated with improved event-free survival and duration of response, but not overall survival.

As reported in the Journal of Clinical Oncology by Flinn et al, 5-year follow-up of the phase III BRIGHT trial has shown improved outcomes with first-line bendamustine/rituximab vs R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) or R-CVP (rituximab plus cyclophosphamide, vincristine, and prednisone) in patients with indolent non-Hodgkin lymphoma or mantle cell lymphoma. In the previously reported primary analysis of the trial, bendamustine/rituximab was shown to be noninferior in complete response rate vs R-CHOP/R-CVP.

In the trial, 447 patients were randomly assigned to receive bendamustine/rituximab (n = 224) or either R-CHOP (n = 104) or R-CVP (n = 119; R-CHOP/R-CVP = 223). Overall, 371 patients had indolent non-Hodgkin lymphoma and 74 were diagnosed with mantle cell lymphoma. Patients were monitored for a minimum of 5 years after completion of study treatment for time-to-event endpoints of progression-free survival, event-free survival, duration of response, and overall survival on investigator assessment.

Treatment Outcomes

Median durations were not reached for any of the time-to-event endpoints in either study group. Progression-free survival at 5 years was 65.5% in the bendamustine/rituximab group vs 55.8% in the R-CHOP/R-CVP group (hazard ratio [HR] = 0.61, P = .0025). Hazard ratios for progression-free survival were 0.70 (P = .0582) among patients with indolent non-Hodgkin lymphoma, 0.40 (P = .0035) among those with mantle cell lymphoma, 0.65 for bendamustine/rituximab vs R-CHOP (P = .0800), and 0.59 for bendamustine/rituximab vs R-CVP (P = .0128).

The bendamustine/rituximab group also exhibited better 5-year event-free survival (HR = 0.63, P = .0020) and duration of response (HR = 0.66, P = .0134).  A total of 58 patients (26%) in the bendamustine/rituximab group vs 83 patients (39%) in the R-CHOP/R-CVP group received new lymphoma treatment (HR for time to new treatment = 0.57, P = .0012). Overall survival at 5 years was 81.7% vs 85.0% (HR = 1.15, P = .5461).

A greater incidence of secondary malignancies was observed in the bendamustine/rituximab group overall (42 vs 24 patients, P = .022) and after 6 months (37 vs 21 patients, P = .032). No new safety data were collected during long-term follow-up.

The investigators concluded: “Overall, bendamustine/rituximab demonstrated better long-term disease control than R-CHOP/R-CVP, and should be considered as a first-line treatment option for patients with indolent and mantle cell lymphoma.”

Ian W. Flinn, MD, PhD, of Sarah Cannon Research Institute, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by Teva Pharmaceuticals. The study authors' full disclosures can be found at jco.ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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