Efficacy
The initial three studies demonstrated improved CR rates from 55 to 58% in the daunorubicin arm to 67 to 80% in the idarubicin arm. The study by Pautas et al.r in patients aged 50 to 70 years compared higher dose daunorubicin 80 mg/m2 x 3 doses with idarubicin 12 mg/m2 x 3 doses and idarubicin 12 mg/m2 x 4 doses. There was an improved CR rate of 83% in the idarubicin 3 dose arm compared to 70% in the daunorubicin 80 mg arm and 78% in the idarubicin 4 dose arm (p=0.04). There was no significant difference in terms of CR after one course, resistant disease and induction deaths.
Figure 1: (A) Event-free survival (EFS) and (B) overall survival (OS)r
© Journal of Clinical 2010
The AML collaborative group has published an overview of randomised trials comparing idarubicin with daunorubicin (and other anthracyclines).r They analysed 7 trials comparing idarubicin to daunorubicin and found no difference in early inductions failures: 20% with idarubicin vs 18% with daunorubicin, however there were increased late induction failures in the daunorubicin arm (29%) vs 17% in idarubicin ascribed to less resistant disease in the idarubicin arm. The overall CR rate was 62% for idarubicin vs 53% for daunorubicin (p=0.002). 81% achieved CR after one course of chemotherapy with idarubicin vs 73% with daunorubicin (p=0.02). There was a higher proportion of patients in first CR at 5 years with idarubicin (14.5% vs 10.5% with daunorubicin). OS was better with idarubicin at 5 years, 13% vs 9% for daunorubicin (p=0.03). A significant trend to improved complete remission rates with idarubicin in younger patients was found.r