Dose-adjusted EPOCH-R compared with R-CHOP as frontline therapy for diffuse large B-cell lymphoma: Clinical outcomes of the phase III intergroup trial alliance/CALGB 50303 Journal Article


Authors: Bartlett, N. L.; Wilson, W. H.; Jung, S. H.; Hsi, E. D.; Maurer, M. J.; Pederson, L. D.; Polley, M. Y. C.; Pitcher, B. N.; Cheson, B. D.; Kahl, B. S.; Friedberg, J. W.; Staudt, L. M.; Wagner-Johnston, N. D.; Blum, K. A.; Abramson, J. S.; Reddy, N. M.; Winter, J. N.; Chang, J. E.; Gopal, A. K.; Chadburn, A.; Mathew, S.; Fisher, R. I.; Richards, K. L.; Schöder, H.; Zelenetz, A. D.; Leonard, J. P.
Article Title: Dose-adjusted EPOCH-R compared with R-CHOP as frontline therapy for diffuse large B-cell lymphoma: Clinical outcomes of the phase III intergroup trial alliance/CALGB 50303
Abstract: PURPOSE Alliance/CALGB 50303 (NCT00118209), an intergroup, phase III study, compared dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (DA-EPOCH-R) with standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) as frontline therapy for diffuse large B-cell lymphoma. PATIENTS AND METHODS Patients received six cycles of DA-EPOCH-R or R-CHOP. The primary objective was progression-free survival (PFS); secondary clinical objectives included response rate, overall survival (OS), and safety. RESULTS Between 2005 and 2013, 524 patients were registered; 491 eligible patients were included in the final analysis. Most patients (74%) had stage III or IV disease; International Prognostic Index (IPI) risk groups included 26% IPI 0 to 1, 37% IPI 2, 25% IPI 3, and 12% IPI 4 to 5. At a median follow-up of 5 years, PFS was not statistically different between the arms (hazard ratio, 0.93; 95% CI, 0.68 to 1.27; P = .65), with a 2-year PFS rate of 78.9% (95% CI, 73.8% to 84.2%) for DA-EPOCH-R and 75.5% (95% CI, 70.2% to 81.1%) for R-CHOP. OS was not different (hazard ratio, 1.09; 95% CI, 0.75 to 1.59; P = .64), with a 2-year OS rate of 86.5% (95% CI, 82.3% to 91%) for DA-EPOCH-R and 85.7% (95% CI, 81.4% to 90.2%) for R-CHOP. Grade 3 and 4 adverse events were more common (P , .001) in the DA-EPOCH-R arm than the R-CHOP arm, including infection (16.9% v 10.7%, respectively), febrile neutropenia (35.0% v 17.7%, respectively), mucositis (8.4% v 2.1%, respectively), and neuropathy (18.6% v 3.3%, respectively). Five treatment-related deaths (2.1%) occurred in each arm. CONCLUSION In the 50303 study population, the more intensive, infusional DA-EPOCH-R was more toxic and did not improve PFS or OS compared with R-CHOP. The more favorable results with R-CHOP compared with historical controls suggest a potential patient selection bias and may preclude generalizability of results to specific risk subgroups. © 2019 by American Society of Clinical Oncology.
Journal Title: Journal of Clinical Oncology
Volume: 37
Issue: 21
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2019-07-20
Start Page: 1790
End Page: 1799
Language: English
DOI: 10.1200/jco.18.01994
PUBMED: 30939090
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 4 September 2019 -- Source: Scopus
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MSK Authors
  1. Heiko Schoder
    305 Schoder
  2. Andrew D Zelenetz
    581 Zelenetz