“The BRIGHT study had a noninferiority design, but I question why BR was not found superior, because the StiL trial showed a huge difference in progression-free survival favoring BR,” said Martin Dreyling, MD, Professor at the University of Munich in Germany. “In BRIGHT, BR achieved higher remission rates than R-CVP (95% vs 83%) but was comparable to R-CHOP (93% vs 90%) in indolent lymphoma, which may be more meaningful than the total numbers for a mixed patient population. Also, the toxicity in BRIGHT was similar between the two arms. My reading is that BR should be less toxic,” he added.

“To put BR in perspective, it is better tolerated and noninferior to R-CHOP. BR is a good alternative to R-CHOP for elderly patients and other patients with poor performance status. To those who claim that BR is the new standard of care, I would say, ‘BR is one of the standards of care for indolent NHL and MCL,’” Dr. Dreyling commented. ■

Disclosure: Dr. Dreyling receives support for clinical trials from Mundipharma.