Efficacy
In the 2013 StiL study by Rummel et al., comparing rituximab and bendamustine (BR) with R-CHOP, the BR arm produced superior response rates.r While the 2014 Bright study by Flinn et al. compared BR with R-CHOP or R-CVP, BR was non-inferior.r Progression-free survival (PFS) was superior in the BR arms in both studies, including the mantle cell lymphoma subgroup. However, no significant overall survival (OS) was observed.
Specific to follicular lymphoma, the 2017 GALLIUM study by Marcus et al.rr randomised the CD20 monoclonal antibody rituximab or obinutuzumab during induction and maintenance in combination with the treating centres choice of bendamustine, CHOP or CVP, in which bendamustine was used in 57%. Overall, the use of obinutuzumab chemotherapy improved PFS compared with rituximab chemotherapy. The improved PFS with obinutuzumab over rituximab persisted in the subgroup of patients receiving bendamustine though there was no difference in response rates. The efficacy of the chemotherapy backbones were not compared in this study, though patients receiving CHOP had higher FLIPI scores and more bulky disease.
Paper |
Study Phase |
Patient population |
Comparator |
Patient Number |
% MCL |
PFS (months) |
CR |
Rummel et al.r
2013
|
3 |
Previously untreated stage 3 or 4 low grade or mantle cell lymphoma requiring treatment |
BR vs R-CHOP |
514 |
BR:18%
R-CHOP: 19%
|
BR: median 69.5
R-CHOP: median 31.2
p<0.001
|
BR: 40%
R-CHOP: 30%
p<0.021
|
Flinn et al.r
2014
|
3 |
Previously untreated stage 2 to 4 low grade or mantle cell lymphoma requiring treatment |
BR vs R-CVP or
R-CHOP
|
447 |
BR: 16%
R-CHOP/ CVP: 17%
|
5-yr PFS BR: 65.5%
R-CHOP/CVP: 55.8%
p=0.0025
|
BR: 31%
R-CHOP/CVP: 25%
p<0.1269
|
Marcus et al.rr
2017
|
3 |
Previously untreated stage 3-4 or bulky stage 2 follicular lymphoma requiring treatment |
Bendamustine/CHOP/CVP + rituximab vs obinutuzumab + maintenance |
1202 (BR 341) |
N/A |
3 yr PFS BR: 76%
R-CHOP: 76%
|
BR: 77%
R-CHOP: 69%
At end of induction by Lugano 2014r criteria
|