Bendamustine Held Superior to CHOP in Patients With Follicular Lymphoma

Throughout my journey with cancer over the last year-and-a-half, I have remained cautiously optimistic. While I had hoped that the “watch and wait” phase would last for a number of years, I was disappointed that within a year I would begin chemotherapy for an ever-growing disease. I completed the recommended chemotherapy protocol of Bendamustine (Treanda) and Rituxan for six cycles.

I was delighted to retain my hair but was less than thrilled to have the incapacitating fatigue that prevented me from returning to work. In the grand scheme, I was fortunate to have minimal side effects and was happy to find after my CT scans that I was in remission.

So, last evening while reading my emails, I noted an update on the Web: New Drug Regimen Edges Out Standard Chemotherapy in Lymphomas. The new drug combination has been shown to more than double the progression-free survival time, according to this German study.

Dr. Mathias Rummel presented updated findings from the Phase III, multicenter Study Group Indolent Lymphomas (Stil) NHL 1 study. In the trial, 549 patients with untreated NHL were randomized to either of the two regimens. Bendamustine (Treanda) plus Rituximab (Rituxan) or the standard CHOP regimen -- Cyclophosphamide (Cytoxan), Doxorubicin (Adriamycin), Vincristine (Oncovin), and Prednisone plus Rituximab.

The combination of CHOP plus Rituximab (R-CHOP) has been the traditional standard of care in the US for follicular lymphoma. That regimen, noted by Dr. Rummel, is associated with a range of adverse effects including cardiac, hematologic, and neurologic toxicity, as well as infectious complications.

After a median follow-up of 45 months, investigators observed a “huge difference” in median progression-free survival among the participants. The study found 69.5 months in the Bendamustine plus Rituximab (B-R) group versus 31.2 months for the R-CHOP group. Both drugs had similar overall rates of response (92.7 percent for B-R and 91.3 percent for R-CHOP), but the Bendamustine combination had significantly more complete responses -- 40 percent versus 30 percent for the CHOP combination.

I read the article several times to be certain that I understood the results: the progression-free survival was nearly six years, as compared with the 2.6 years in the standard therapy. Thanks to my “evidence-based practice” oncologist, I had received the most beneficial and effective treatment. This was the first time I felt like shouting from the rooftop, and maybe there would be time to do all the things on my bucket list.

My maintenance Rituxan treatment is scheduled for next week, and I will cautiously inquire as to the timeframe for my next scan. Anticipating that I might not be around to see my seven-year-old granddaughter reach milestones, I had already started a “gift box” that contains special-occasion gift cards (sweet sixteen, graduation, etc.), outlining which piece of jewelry she should receive, with a personal note from me. This was started early in my cancer journey. I now have a glimmer of hope that I will personally be able to give her these gifts as the time arrives.

These results are the best early birthday present I could receive. I will continue to practice my yoga, set my priorities, and enjoy each day as a gift.

References:
Rummel, MJ, Niederle, N, Maschmeyer G, et al. (2012) Bendamustine plus Rituximab (B-R) versus CHOP plus rituximab (CHOP-R) as first line treatment in patients with indolent and mantle cell lymphomas (MCL): Updated results from the Stil NHL 1 study. Journal of Clinical Oncology, 30:Jsuppl; abstr 3.