Mark Roschewski, MD, National Cancer Institute, Bethesda, Maryland, discussed the potential role for first-line, dose-adjusted (rituximab, etoposide phosphate, prednisone, vincristine sulfate, cyclophosphamide, and doxorubicin hydrochloride) treatment of EPOCH-R among patients with aggressive B-cell lymphomas.

These insights and data were presented at the 2024 Pan Pacific Lymphoma (PPL) Conference in Lahaina, Hawaii.

Transcript:

My name is Mark Roschewski. I'm a clinical investigator here at the National Cancer Institute (NCI) with a focus on lymphomas, specifically aggressive B-cell lymphomas.

My talk at the Pan Pacific Lymphoma Conference was to discuss the potential role for dose-adjusted [rituximab, etoposide phosphate, prednisone, vincristine sulfate, cyclophosphamide, and doxorubicin hydrochloride] (EPOCH-R) in the frontline treatment of patients with aggressive B-cell lymphomas.

The unique things about this regimen are that it is delivered continuously, and the doses of chemotherapy can increase with each cycle. Now this was developed at the NCI, and it was developed specifically to overcome chemotherapy resistance in highly proliferative tumors. That was its original intent, and it's been around for a while. It's used in many situations.

One of the key studies was when it was compared to (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, prednisone) R-CHOP and a randomized study. There wasn't an appreciable difference in outcomes when using this regimen compared to R-CHOP. One of the limitations of that study was that there weren't a lot of high-risk patients included. So, there's still been some question whether patients that have high-risk features would actually benefit from this regimen as opposed to a more standard approach with something like R-CHOP or even R-pola(polatuzumab vedotin-piiq)-CHP.

The discussion here was about what would be the rationale. Most of it centers on the high-risk features of the case presented, the high proliferation index, and the presence of both a MYC rearrangement and a BCL6 rearrangement. So, those tumors are considered to be higher risk for progression.

There is [also] some retrospective data that suggests that there's an improvement in both progression-free and even potentially overall survival when one uses regimens such as dose-adjusted EPOCH-R. I argue that that was a rational approach for the patient presented. One does have to be careful about some of the risks of this regimen, specifically neuropathy, if it's not carefully dose-reduced of vincristine.

But other than that, this can be employed in most settings, and I think was a very rational choice for the patient presented.

Source:

Roschewski M. Choosing Initial Therapy Wisely: Dose-Adjusted EPOCH-R for Advanced Stage Large B-Cell Lymphoma. Presented at the 2024 Pan Pacific Lymphoma Conference. July 15–19, 2024; Lahaina, HI.