The combination of carfilzomib (C) plus rituximab, ifosfamide, carboplatin and etoposide (RICE) resulted in high complete remission (CR) rates and longer progression-free survival (PFS) among patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL), and especially for non-germinal center B-cell like (GCB) DLBCL patients, according to research presented at the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting.

“The CORAL study highlighted the need to develop novel salvage regimens for [R/R] DLBCL previously treated with R+CHOP,” stated Mody Amin, MD, University at Buffalo, Buffalo, New York and colleagues.

This phase 1/2 trial compared the clinical outcomes of 28 patients with R/R DLBCL who were treated with C-RICE versus 38 patients who were treated with RICE. Study endpoints consisted of differences in overall response rate (ORR), complete response (CR)/partial response (PR) rates, median PFS and overall survival (OS) between the 2 cohorts.

Results demonstrated that addition of carfilzomib to RICE resulted in improved clinical outcomes. It was noted that a higher ORR (92.9 vs 76.3, P = 0.073) and CR rates (82.1 vs  44.7, P = 0.002) were observed in C-RICE vs. RICE treated patients. Additionally, a multivariate analysis confirmed there were higher CR rates in patients treated with C-RICE vs RICE when adjusted by DLBCL subtype (GCB vs non-GCB, P = 0.003).

More patients treated with C-RICE proceeded with a regimen of high-dose chemotherapy and autologous stem-cell support (HDC-ASCS) (52.6% vs 47.4%, P = 0.618). Investigators noted that the 3-year PFS rate was higher among patients in the C-RICE cohort (54%, 32 to 72%) than the RICE treatment cohort (35%, 19 to 51%). While the median PFS measured longer in the C-RICE cohort at 36.8m (0.8 to 73.2) vs 3.2m (0.5 to 54.2) in the RICE cohort, it did not reach statistical significance (P = 0.714). No differences in OS were observed between patients in the C-RICE & RICE cohorts, with a median OS measuring 67.3m vs 71.8m.

“The C-RICE outcomes were more striking in patients with non-GCB R/R DLBCL. CR-ICE led to high CR rates and longer PFS among R/R DLBCL patients, especially in non-GCB DLBCL patients,” concluded Dr Amin et al.

“C-RICE could be an attractive regimen to achieve disease control in r/r DLBCL patients undergoing consolidation therapy with HDC-ASCT or CAR T-cell therapy,” they added.

Source:

Amin M, Niu A, Attwood K, et al. Carfilzomib plus rituximab, ifosfamide, carboplatin and etoposide (C-RICE) led to higher response, OS, and PFS in patients with transplant-eligible relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL). Presented at the ASCO Annual Meeting. May 31-June 4, 2024; Chicago, IL. Abstract 7042