Wednesday, June 14, 2017

ASCO: R-B vs R-CHOP

One more from ASCO: a long-term follow-up of a study of Bendamustine + Rituxan vs. CHOP + Rituxan for indolent NHL patients. The B-R patients did better in almost all measures.

(Let's be clear here -- this study looks at indolent NHL, so Follicular Lymphoma is included, but the results aren't just about FL, and the abstract doesn't separate them out.)

The really important part of this study (known as the StiL NHL 1 Study) is that it compares the two treatments over 9 years. The researchers reported on the results of this study at the 5 year mark, and now they are showing updated results, with estimates for 10 years.

One important point -- the Overall Survival rate for both treatments is just about the same, at least by statistical measures. The estimated 10 year survival for the B-R group was 71%, and for CHOP is was 66%. A small difference, but not a statistical difference. Taking one over the other won't result in (statistically) living longer.

But for other measures, Bendamustine came out on top.


The median Time to Next Treatment (TTNT) was 56 months (almost 5 years) for the CHOP group, but the median hadn't yet been reached for the Bendamustine group. (The median is the number right in the middle -- half are more and half are less. So less half of the patients in the Bendamustine group had received a second treatment.)

The Bendamustine patients also had fewer second-line treatments (which makes sense, given the TTNT) -- 32%, while 51% of CHOP patients received a second treatment.

As for side effects, one measure is secondary malignancies -- how many patients developed a new cancer. Bendamustine does a little better there, too -- 36 patients, while 39 CHOP patients developed secondary malignancies.

For me (and my non-expert opinion), it seems like R-Bendamustine is a very good choice. (It really didn't take an expert to see that.) It's great to see long-term results that back up the short-term results.

But at the same time, it's important to remember that R-CHOP absolutely has a place in our treatment plan. My oncologist had planned to save CHOP in case of transformation, and that's still the way I think of it, given the fairly indolent course that my Follicular Lymphoma has taken. I know lots of folks who have had CHOP as a first-line treatment, and that's great, too. The point is, it's a still an excellent tool for us all.

It makes me wonder what long-term results will look like for some other exciting treatments, too.

I'm looking forward to seeing those.

4 comments:

Anonymous said...

Dear Bob,
Is it possible to get B+R as a second treatment, after R-CHOP?
Thanks
Rodrigo

Lymphomaniac said...

Hi Rodrigo. Nice to hear from you.
Yes, it is possible to follow R-CHOP with B+R. In the study that I write about here, about about 46% of the patients who had R-CHOP followed it with B+R. And it works the other way, too -- about 36% of the patients who had B+R then followed it with R-CHOP.

I hope you are doing well.
Bob

Romencar Rodrigo said...

Great, Bob.
One of the goog things about FL is that we have some many options to face it!
I'm doing great. Today is my 5y6months aniversary.
My hematologisty told me that perhaps, in a very near future, all of those medications will be avoid.
He is an optmistic. He thinks that a pill or two per day will be able to control our disease.
Rodrigo

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