Expert Point of View: Michael Williams, MD

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Michael Williams, MD, the Byrd S. Leavell Professor of Medicine and Chief of Hematologic Malignancies at the University of Virginia Cancer Center, Charlottesville, commented, “Bendamustine/rituximab provides equivalent or better responses vs R-CHOP [rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone], and with less toxicity.”

The study’s caveats are that progression-free survival was relatively short for follicular lymphoma patients treated with R-CHOP, and overall survival is not yet different. Long-term toxicities are also still unclear, as is the ability to collect stem cells following bendamustine treatment, although this did not appear problematic in the StiL study, he noted.

Next Steps to Validate Outcomes

The next steps should be to validate outcomes in larger cohorts of indolent non-Hodgkin lymphoma (NHL) subtypes and verify the short- and long-term toxicities. Optimal combinations should also be determined, and the drug’s activity in other lymphomas should be explored, he suggested.

Meanwhile, he said, “StiL NHL1 establishes bendamustine/rituximab as a front-line regimen for indolent B-cell and non–transplant-eligible mantle cell lymphoma patients.”

The regimen is being further evaluated in U.S. Cooperative Group trials, in the StiL NHL 7-2008 trial (bendamustine/rituximab followed by rituximab maintenance), and the BRIGHT study (bendamustine/rituximab vs R-CHOP or R-CVP [rituximab plus cyclophosphamide, vincristine, and prednisone]). ■

Disclosure: Dr. Williams had disclosures for Celgene, Cephalon, Genentech, TG Therapeutics, Onyx, Calistoga Pharmaceuticals, Genentech, Gilead Sciences, Millennium, Novartis, and Pharmacyclics.

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