Excellent outcomes were experienced in patients with Stage I or II diffuse large B-cell lymphoma (DLBCL) who received reduced chemotherapy and no radiation treatment in a recent collaborative National Clinical Trials Network Study (J Clin Oncol. 2020;38[26]:3003-3011. doi:10.1200/JCO.20.00999).
“In the absolute majority of DLBCL patients presenting with limited stage disease, we can safely reduce the number of treatments and omit radiation,” said Daniel Persky, MD, Division of Hematology and Oncology, University of Arizona, Tucson, AZ.
The aim of the study was treatment improvement for patients with DLBCL, which presents as a limited-stage disease in 25% to 30% of patients with better overall survival than that for advanced-stage disease.
Patients received 3 cycles of standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and PET/computed tomography scan (iPET). With a negative iPET result, treatment included an additional cycle of R-CHOP. If positive, patients did not proceed with additional cycles of R-CHOP. Instead, they received field radiation therapy followed by ibritumomab tiuxetan radioimmunotherapy.
Of the 132 eligible patients, 128 underwent iPET, which was positive in 11%.
“The interim PET positive group were those at greater risk of relapse or recurrence of their cancer,” Dr Persky said. “This group also did really well in the study.”
The 5-year progression-free survival estimate was 87% (95% CI, 79%-92%) and the overall survival estimate was 89% (95% CI, 82%-94%). Similar outcomes were shown for iPET-positive and iPET-negative patients.
“This can be the new standard of care for limited stage DLBCL patients,” Dr Persky said. “Many patients can forgo radiation and receive less chemotherapy while still getting excellent results.”—Lisa Kuhns
