Catovsky et al (2007)r found that overall survival was the not statistically different between the three arms of the study. However, both complete (CRR) and overall response rates (ORR) were better in the fludarabine and cyclophosphamide arm than in the fludarabine arm, which in turn was better than the chlorambucil arm. These results are summarised in the table below.
Overall survival and progression free survival data:r
© Lancet 2007
The CLL Trialists' Collaborative Group (1999)r meta-analysis of over 2000 patients showed an identical 5 year survival of 48% in both groups. Six of the 10 studies included an anthracycline and a subgroup analysis of these trials showed no survival advantage compared with chlorambucil.r
Fludarabine has been show to have a higher ORR, CR rate and duration of response than chlorambucil or anthracycline containing combination chemotherapy. There was no statistically significant difference in the survival for patients receiving fludarabine although the crossover nature of some of these studies and the high response rate to second line treatment may have influenced these results.
More recent studies comparing fludarabine and cyclophosphamide with fludarabine have shown a prolonged progression free survival for patients receiving the combination therapy.r
© Journal of Clinical Oncology 2014