01 June 2020

A new combination therapy for patients with Burkitt’s lymphoma has less toxicity for patients with the same effectiveness as standard treatments, it has been reported.

Known as the dose-adjusted (DA)-EPOCH-R regimen, it is a combination of etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab, tailored to an individual patient’s ability to tolerate the drugs. The regimen infuses chemotherapy over 96 hours for each cycle, rather than using short bursts of chemotherapy which can cause acute side-effects.

The treatment was developed by Dr Wyndham Wilson, of the NIH Clinical Center in Bethesda, Maryland, USA, as a less toxic alternative to the current dose-intensive chemotherapy. An earlier pilot study of 30 adult patients given DA-EPOCH-R suggested that it was effective.

In the new study, the regimen was given to 113 patients at 22 research centres across the US. Participants with low- and high-risk disease were enrolled, and were aged 49 years on average.

Overall survival was 87% and the four-year event-free survival rate was 84.5%. This varied from 100% event-free survival for low-risk patients, to 82% for high-risk patients.

DA-EPOCH-R was deemed effective across age groups, regardless of HIV status. A “relatively low number of patients” experienced severe chemotherapy side effects, the team reported in the Journal of Clinical Oncology.

Five treatment-related deaths occurred in the study. Patients with disease in the central nervous system had the highest risk of treatment-related death or treatment failure. The researchers say that further studies are warranted to determine how best to treat patients with evidence of disease in the cerebrospinal fluid.

Co-author Dr Mark Roschewski said: “We knew Burkitt lymphoma is curable with dose-intensive chemotherapy, but that treatment can be acutely toxic for adult patients.

“With this finding, we not only have a potentially curative treatment option for these patients that's less toxic, but one that appears effective for most adults, including elderly patients and those with HIV and other comorbidities who might not be able to receive standard treatment.”

Source: Roschewski M, Dunleavy K, Abramson JS, Powell BL, Link BK, Patel P, Bierman PJ, Jagadeesh D, Mitsuyasu RT, Peace D, Watson PR, Hanna W, Melani C, Lucas AN, Steinberg SM, Pittaluga S, Jaffe ES, Friedberg JW, Kahl BS, Little RF, Bartlett NL, Fanale  MA, Noy A, Wilson WH (2020) “Multicenter Study of Risk-Adapted Therapy With Dose-Adjusted EPOCH-R in Adults With Untreated Burkitt Lymphoma”, J Clin Oncol, doi: 10.1200/JCO.20.00303


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