Long-term follow-up results of the FOLL05 trial confirm the efficacy of immunochemotherapy regimens for patients with previously untreated advanced-stage follicular lymphoma, according to findings of a post-hoc analysis recently published in the <em>Journal of Clinical Oncology </em>covering a median 7 years of follow-up.
Long-term follow-up results of the FOLL05 trial confirm the efficacy of immunochemotherapy regimens for patients with previously untreated advanced-stage follicular lymphoma (FL), according to findings of a post-hoc analysis recently published in theJournal of Clinical Oncologycovering a median 7 years of follow-up.1In the prospective study, there was an 8-year overall survival (OS) rate of 83% seen across 3 regimens with different chemotherapy backbones.
The investigators suggested a preference for frontline R-CHOP (rituximab [Rituxan] plus cyclophosphamide, doxorubicin [Adriamycin], vincristine, and prednisone), following the results of the trial, as R-CHOP demonstrated similar survival benefits but an improved safety profile and a reduced risk of needing additional therapy compared with the 2 other regimens studied.
“This long-term update of the FOLL05 trial confirms the high efficacy of immunochemotherapy for the initial treatment of patients with advanced-stage follicular lymphoma in need of therapy. In addition, with the longer follow-up, we can conclude that if the aim of initial therapy is to maximize treatment activity and increase the chance of durable disease control, R-CHOP should be the preferred option among the 3 regimens,” Stefano Luminari, MD, and his co-authors wrote in the report of the updated findings.
In the randomized, open-label multicenter phase III FOLL05 trial, 534 patients were originally randomized to 1 of 3 immunochemotherapy treatment arms: R-CVP (rituximab plus cyclophosphamide, vincristine, and prednisone; arm A), R-CHOP (arm B), or R-FM (rituximab plus fludarabine and mitoxantrone; arm C).
Of the 504 patients eligible for the intent-to-treat analysis, the median age was 55 years (range, 30-75), more than half were male, and the majority had a FLIPI score of 0 to 2. Patients had grade 1 to 3a FL by World Health Organization classification and Ann Arbor stage II to IV disease.
The primary analysis followed patients for a median of 34 months and demonstrated a 3-year time to treatment failure (TTF) of 46% in arm A, 62% in arm B, and 59% in arm C. At 3 years, the progression-free survival (PFS) rates were 52%, 68%, and 63%, respectively.2
While each of the regimens were generally tolerated, there was a higher degree of grade 3/4 adverse events (AEs) seen in arm C. Grade 3/4 neutropenia was seen in 28% of patients treated with R-CVP, 50% with R-CHOP, and in 64% of patients in the R-FM arm. Grade 3/4 thrombocytopenia was experienced by 0%, 3%, and 8% of patients treated with R-CVP, R-CHOP, and R-FM, respectively. Five cardiac events were observed, including 2 of grade 3/4 (1 each from the R-CVP and R-CHOP arms). There were no treatment-related deaths in the study.
In the long-term analysis, the 8-year TTF was 45% with R-CHOP compared with 38% with R-CVP (HR, 0.73; 95% CI, 0.55-0.98;P= .033), and 49% with R-FM (HR compared with R-CVP, 0.70; 95% CI, 0.52-0.93;P= .016). Overall, the 8-year TTF was 44% (95% CI, 39%-49%) across the 3 treatment arms. PFS at 8 years was 42%, 49%, and 52% in arms A, B, and C, respectively, and 48% (95% CI, 43%-52%) overall.
When adjusting for FLIPI2 scores, the hazard ratio for PFS for R-CHOP versus R-CVP was 0.73 (95% CI, 0.54-0.98;P= .037), and the hazard ratio was 0.67 for R-FM versus R-CVP (95% CI, 0.50-0.91;P= .009).
Analysis of the intention-to-treat population demonstrated an OS of 85% (95% CI, 77%-91%) at 8 years for R-CVP, 83% (95% CI, 75%-89%) with R-CHOP, and 79% (95% CI, 71%-85%) with R-FM (P= .243). Stable responses (complete or partial) were experienced by 41% in arm A, 51% in arm B, 51% in arm C, or 47% overall.
“Considering the updated results, we conclude with high confidence that patients treated with R-CHOP had a lower risk of progressive disease than those treated with R-CVP. In addition, our analysis of OS suggests that survival is similar between R-CHOP and R-CVP,” the co-authors wrote.
Within the study, 248 patients had primary refractory disease or had experienced progression or relapse. Of these, 208 (41%) required salvage treatment, of which 90 received conventional immunochemotherapy, 75 had autologous stem cell transplant, 33 received immunotherapy, and 10 had subsequent radiotherapy. Patients who were initially randomized to R-CVP had a higher risk for requiring a second-line therapy (55%) versus 38% with R-CHOP and 32% with R-FM (P<.001).
Secondary malignancies were reported in 41 patients, including 14 hematologic malignancies, 27 solid tumors, and 11 patients had a histologic transformation of their disease. The median time to development of secondary malignancy was 33 months (range, 8-96). A higher incidence of secondary malignancies was seen in arm B (12%) at 8 years compared with 6.2% in arm A and 9.6% in arm C.
Non-lymphomarelated risk of death was higher with R-FM than R-CVP (11.2% vs 1.8% at 8 years;P= .005), no statistically significant difference was demonstrated between the 2 in non-lymphomarelated cause-specific mortality (P= .157).
“Our cause-specific mortality data provide a better description of the consequences of late events for patient survival, focusing on life-threatening events and reducing the impact of curable conditions that are also subject to under-reporting. Patients treated with R-FM had high rates of secondary malignancies and a higher risk of dying as a result of causes unrelated to lymphoma progression compared with those receiving R-CVP,” Luminari et al wrote.
The authors also noted that these results compared favorably with that of similar studies, supporting the preference for R-CHOP.
References:
Does Odronextamab Show Hope in FL and DLBCL Despite Regulatory Hurdles?
November 5th 2024Despite regulatory challenges from the FDA, odronextamab has received European approval for the treatment of patients with relapsed/refractory follicular lymphoma or diffuse large B-cell lymphoma following 2 prior treatments.
Read More