R-CHOP Followed by R-ICE Regimen vs Standard-of-Care Therapy for Patients With Non-GCB DLBCL

Andrew Zelenetz, MD, Memorial Sloan Kettering Cancer Center, New York, New York, discusses the significance of long-term data on potential improved outcomes from rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) induction followed by rituximab, ifosfamide, carboplatin, and etoposide ([R]-ICE) consolidation treatment vs the standard-of-care treatment among patients with non-germinal center B-cell-like (non-GCB) diffuse large B-cell lymphoma (DLBCL). 

Transcript:

Hi, I am Andrew Zelenetz, attending physician at Memorial Sloan Kettering Cancer Center in New York, and a member of the Lymphoma Service. [So], what's next with R-CHOP ICE? The data that we published is very long-term follow-up data. By its definition, it's sort of “old school treatment.” But the reason why we thought that this was very important to be available is the results are really excellent. They're very long-term results. 

We know what the late toxicities are about, and the cost of therapy is substantially less than what I think is now an alternative, [that] would be rituximab, cyclophosphamide, doxorubicin, prednisone, and polatuzumab vedotin, or R-ChP-pola. 

This regimen showed a small, about 6%, improvement in long-term outcome progression-free survival over R-CHOP, [and] no overall survival difference. Our study suggests that there is an overall survival difference for the entire population, and obviously most of this is derived from the non-germinal center population. And this [treatment] is substantially less expensive. This is not modern therapy. This is not adding $200,000 or $300,000 to the cost of treatment. 

My feeling is that we have long-term follow-up of a very cost-effective regimen with excellent outcomes. Yes, we could start to include and add some of the newer novel agents to this regimen, and in fact, we could even add polatuzumab to the regimen and ask does it improve the outcome? But I think the rationale for publishing this result was that [they were] long-term outcomes, long-term data with very good outcomes for an adverse group of patients.

Source:

Bantilan K, Smith A, Maurer J, et al. Matched control analysis suggests R-CHOP followed by (R)-ICE may improve outcome in non-GCB DLBCL compared to R-CHOP. Blood Adv. Published online January 25, 2024. doi: 10.1182/bloodadvances.2023011408