ASCO 2014 Report — Malignant Hematology

Meeting Report |
June 16, 2014

ASCO 2014 Report — Malignant Hematology

  1. Michael E. Williams, MD, ScM

Highlights of new strategies for patients with lymphoma and myeloma

  1. Michael E. Williams, MD, ScM

At this year's annual meeting of the American Society of Clinical Oncology (ASCO 2014), held May 30 through June 3 in Chicago, specialists discussed the latest cancer research. The editors of NEJM Journal Watch Oncology and Hematology were on hand to cover key presentations at the conference. Here, Michael E. Williams, MD, ScM, reviews new findings in malignant hematology.

Bortezomib Effective for Mantle Cell Lymphoma

Cavalli and colleagues conducted a multicenter, randomized, phase III trial (abstract 8500) involving 487

newly diagnosed mantle cell lymphoma patients ineligible for bone-marrow transplant to test the substitution of bortezomib (an active single agent in the relapsed setting) for vincristine in the standard R-CHOP-21 regimen (rituximab, cyclophosphamide, doxorubicin, and prednisone plus vincristine). Patients received treatment for a median of six cycles. At a median follow-up of 40 months, median progression-free survival (PFS; the primary outcome) was significantly improved with bortezomib versus vincristine (24.7 vs. 14.4 months; P<0.001); 4-year overall survival (OS) was also improved with bortezomib (64% vs. 54%). Rates of peripheral neuropathy were similar, but grade 3–4 thrombocytopenia was more common with bortezomib.

Gender, Age, and Rituximab Response

Elderly men with diffuse large B-cell lymphoma (DLBCL) have been found to have more rapid rituximab clearance than elderly women, leading to lower rituximab serum levels and poorer outcomes. Now, Pfreundschuh and colleagues have conducted a randomized, phase II study (SEXIE-R-CHOP-14; abstract 8501) of newly diagnosed patients with DLBCL (ages, 61–80), in which 148 men received rituximab (500 mg/m2) and 120 women received the standard dose (375 mg/m2). The 3-year PFS was similar for men and women (74% and 68%, respectively), which abrogated the inferior PFS and OS observed for men in an earlier comparator study. It was also noted that younger men and women have more-rapid clearance than do older women, suggesting that the dose for them is suboptimal in most current regimens. Whether the standard dose is indeed optimal, even for elderly women, remains undetermined.

Post-Treatment PET Predicts Survival in Follicular Lymphoma

Trotman and colleagues conducted a central review (abstract 8502) of positron emission tomography (PET) scans from 246 patients treated with induction therapy in three multicenter follicular lymphoma clinical trials. PET results were independently scored by three nuclear medicine radiologists using a 5-point scale, with 1 being negative. Using a cutoff score of 4 (tumor site uptake > liver uptake), the 4-year PFS rates for PET-positive and PET-negative patients were 23.2% and 63.4% (P<0.0001), and 4-year OS rates were 87.2% vs. 97.1% (P<0.0001). PET is now recommended following rituximab-based chemotherapy induction for patients with follicular lymphoma.

Combination Therapy Effective for Relapsed/Refractory Myeloma

Richardson and colleagues conducted a randomized, double-blind, placebo-controlled, multicenter, phase III trial (Panorama 1; abstract 8510) to test the pan-HDAC (histone deacetylase) inhibitor panobinostat versus placebo, each in combination with bortezomib and dexamethasone in 768 patients with relapsed or refractory multiple myeloma. PFS, the primary study endpoint, was significantly improved with panobinostat versus placebo (12.0 vs. 8.1 months; P<0.0001); overall response was similar (61% and 55%, respectively), but with a trend to higher complete or near-complete response with panobinostat (28% vs. 16%). More toxicity was observed with panobinostat — primarily thrombocytopenia, neutropenia, and diarrhea — with 36% treatment discontinuation due to adverse events, as compared with 20% with placebo.

Editor Disclosures at Time of Publication

  • Disclosures for Michael E. Williams, MD, ScM at time of publication Consultant / Advisory board Celgene; Millennium; TG Therapeutics Speaker's bureau Research To Practice; ION; Xcenda Grant / Research support Celgene; Janssen; Allos; Genetech; Millennium; Pharmacyclics; Gilead; Bristol-Myers-Squibb; Cephalon Editorial boards American Board of Internal Medicine, Hematology; Current Treatment Options in Oncology

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