Dose-Adjusted EPOCH Regimen Yielded Deep and Durable Remissions Among Patients With ALL

Results from a Phase 2 Trial

According to findings from a phase 2 trial recently published in Leukemia & Lymphoma, a dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-EPOCH) regimen yielded deep and durable remissions among patients with acute lymphoblastic leukemia (ALL). DA-EPOCH was found to be comparable with some forms of resource-intensive treatment strategies, but with a low rate of treatment-related death. 

According to Ryan D. Cassaday, Fred Hutchinson Cancer Center, Seattle, Washington, “Treatments for adults with newly-diagnosed acute lymphoblastic leukemia (ALL) may be prohibitively toxic and/or resource-intense.” 

To attempt to address this issue, Dr Cassaday et al aimed to evaluate the efficacy and safety of DA-EPOCH as a potential treatment regimen for adults with newly-diagnosed ALL. The primary endpoint was an assessment of measurable residual disease (MRD) negativity. 

53 adult patients with newly-diagnosed ALL, including 28 with Ph+ disease and 25 with Ph- disease, were enrolled in this trial. All patients had 1 or more high-risk clinical features. All patients were administered DA-EPOCH treatment. Additionally, patients with Ph+ disease were given imatinib and dasatinib, and rituximab was added for patients who were CD20+. 

Results indicated that within 4 treatment cycles,  MRD negativity was achieved in 71% of patients with Ph+ ALL and 64% of patients with Ph- ALL. The median overall survival was 49 months, and the 2-year overall survival rate was 71%. 47 patients received morphologic remission, and of these patients, the median relapse-free survival was 24 months, with a 2-year relapse-free survival rate of 57%. The early mortality rate was very low, as it was observed to be only 2%. 

In conclusion, the DA-EPOCH treatment regimen offered viable efficacy and safety among adults with newly-diagnosed ALL, significantly deepening remissions. Additionally, the median overall survival and relapse-free survival rates suggest the potential long-term disease control of this treatment. 

As endpoints were met, Dr Cassaday and coauthors stated, “DA-EPOCH yields deep and durable remissions in adults with ALL comparable to some resource-intense strategies but with a low rate of treatment-related death.” 

Source: 

Cassaday RD, Zarling LC, Garcia KLA, et al. Phase II study of dose-adjusted EPOCH as initial therapy for adults with high-risk acute lymphoblastic leukemia. Leukemia & Lymphoma. Published online March 20, 2023:1-11. doi:10.1080/10428194.2023.2189803