Dr. Westin on Potential for Chemo-Free Treatment in Large Cell Lymphoma

Jason Westin, MD, MS, FACP, director, Lymphoma Clinical Research, section chief, Aggressive Lymphoma, and associate professor, Department of Lymphoma/Myeloma, Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center, discusses the potential for a chemotherapy-free future in large cell lymphoma.

For patients with diffuse large B-cell lymphoma, one option in the frontline setting is to modify the chemotherapy, says Westin. Dose-adjusted rituximab (Rituxan), etoposide phosphate, prednisone, vincristine sulfate, cyclophosphamide, and doxorubicin hydrochloride (R-EPOCH) is a modified version of rituximab (Rituxan), cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), explains Westin. The combination of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD) or cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate (CODOX-M) are also modified versions of R-CHOP, which are all largely based on 1970s chemotherapy.

Multiple attempts to add targeted agents to R-CHOP have been made, says Westin; however, this approach has failed because the chemotherapy drugs do not synergize well with new targeted agents. At The University of Texas MD Anderson Cancer Center, multiple clinical trials are evaluating the combination of targeted agents for newly diagnosed patients with large cell lymphoma, and response rates above 80% are being observed without any chemotherapy. The data are still immature and require more follow-up, but there is potential for a chemotherapy-free future for large cell lymphoma, concludes Westin.