In a recent study reported in the Journal of Clinical Oncology,1 an alternative treatment regimen that is less toxic than standard dose-intensive chemotherapy was found to be highly effective for adults with Burkitt lymphoma across all age groups and independent of HIV status. In addition to being better tolerated, the regimen, called dose-adjusted EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin plus rituximab), is already an option for diffuse large B-cell lymphomas and can be administered in an outpatient setting.
The study was led by researchers in the Center for Cancer Research at the National Cancer Institute (NCI), part of the National Institutes of Health (NIH), and sponsored by the NCI’s Cancer Therapy Evaluation Program. It was conducted at 22 research centers across the country. The dose-adjusted EPOCH-R regimen was originally developed by NCI researchers led by Wyndham Wilson, MD, PhD, at the NIH Clinical Center in Bethesda, Maryland.
Wyndham Wilson, MD, PhD
Mark Roschewski, MD
“We knew Burkitt lymphoma is curable with dose-intensive chemotherapy, but that treatment can be acutely toxic for adult patients,” said Mark Roschewski, MD, of the NCI’s Lymphoid Malignancies Branch, who was one of the lead authors on the study. “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.”
Researchers conducted a large, multicenter phase II study, enrolling 113 patients identified as having low- or high-risk disease, based on characteristics such as tumor bulk and performance status. The median patient age was 49 years, and 62% of study participants were 40 years or older.
At a median follow-up of almost 5 years, the researchers calculated the 4-year rate of event-free survival was 84.5%, with an overall survival rate of 87%. For low-risk patients, event-free survival was 100%, and for high-risk patients, it was 82%. The treatment was effective across age groups, including patients in their 70s and 80s, and regardless of HIV status. The treatment was well tolerated, with a relatively low number of patients experiencing severe side effects.
These findings suggest that highly dose-intensive chemotherapy may not be necessary and that carefully defined low-risk patients may be treated with limited chemotherapy. Furthermore, patients can receive EPOCH-R in an outpatient setting, an alternative to the prolonged hospitalization required to receive highly dose-intensive chemotherapy.
Five treatment-related deaths occurred in the study. The researchers found that patients in the study who had disease in the central nervous system, specifically in the cerebrospinal fluid, had the highest risk of treatment-related death or treatment failure. Further studies are warranted to determine how best to treat patients with cerebrospinal fluid involvement, the researchers said.
DISCLOSURE: For full disclosures of the study authors, visit ascopubs.org.
1. Roschewski, M, Dunleavy, K, Abramson, JS, et al: Multicenter study of risk-adapted therapy with dose-adjusted EPOCH-R in adults with untreated Burkitt lymphoma. J Clin Oncol. May 26, 2020 (early release online).