Expert Point of View: Bruce D. Cheson, MD

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Bruce D. Cheson, MD

Bruce D. Cheson, MD

BRUCE D. CHESON, MD, Director of the Division of Hematology/Oncology at the Lombardi Comprehensive Cancer Center, Washington, DC, agreed that rituximab (Rituxan) plus lenalidomide (Revlimid; R2) is a reasonable first-line option, considering the findings of the RELEVANCE trial. 

“Dr. Fowler showed that best objective response rates were similar between R2 and rituximab-chemotherapy, as was the co-primary endpoint of complete remission and complete remission unconfirmed at 120 weeks. The progression-free survival curves were superimposable,” he noted. 

“Unfortunately, RELEVANCE was designed as a superiority trial, not a noninferiority trial, and therefore it failed to meet the primary endpoint. However, R2 showed similar progression-free survival at 120 weeks in all major subgroups, and overall survival was similar,” he said. “It also was associated with less nonhematologic toxicity, except for rash, and less neutropenia and febrile neutropenia as well as fewer infections, despite less use of growth factors,” he said. Since the two arms were comparable in terms of efficacy, the follow-up quality-of-life data, which are pending, “will be of considerable interest,” he added. 

Road to Chemotherapy-Free World 

R2 IS ONE of the emerging regimens leading the field toward “a chemotherapy-free world” for some hematologic cancers, Dr. Cheson commented. “There are increasing settings where chemotherapy-free regimens can replace chemotherapy, but a chemotherapy-free regimen does not have to be more effective than chemotherapy,” he said. 

“You have to look at the risk/benefit of the two approaches,” Dr. Cheson maintained. “Single nonchemotherapy agents are active, but they are not sufficient to get us where we want to go. We need to carefully develop rational combinations and identify biomarkers for response, resistance, and toxicity. 

“Soon,” he predicted, “chemotherapy will be relegated to historical interest only, and chemotherapy-free is the approach that will lead us to a cure.” ■

DISCLOSURE: Dr. Cheson has served as a consultant or advisor for AbbVie, Acerta Pharma, Bayer, Celgene, MorphoSys, Pharmacyclics/Janssen, Roche/Genentech, Sunesis Pharmaceuticals, and TG Therapeutics. 

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