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At this year's meeting of the American Society of Clinical Oncology (ASCO 2019), held May 31 to June 4 in Chicago, investigators discussed the latest findings in cancer research. The editors of NEJM Journal Watch Oncology and Hematology were on hand to report highlights of the conference. Here, Michael E. Williams, MD, ScM, reviews key presentations on new treatments for patients with multiple myeloma, peripheral T-cell lymphoma, and diffuse large B-cell lymphoma. All meeting abstracts can be viewed in the (ASCO meeting library).
Lonial and colleagues conducted the phase II/III ECOG E3A06 trial (abstract 8001) to assess whether single-agent lenalidomide could prevent or delay the onset of clinically overt myeloma in 182 patients who had high-risk smoldering multiple myeloma with ≥10% bone marrow plasma cells and an abnormal serum free light chain ratio without disease-defining myeloma features. Patients were randomized to lenalidomide or observation.
Progression-free survival (the primary endpoint) at 1, 2, and 3 years was superior for lenalidomide versus placebo (98%, 93%, 91% vs. 89%, 76%, 66%, respectively; hazard ratio, 0.28; P=0.0005). Toxicities were as expected; 80% of phase II and 51% of phase III patients discontinued lenalidomide due to adverse events or patient withdrawal. Rates of second primary malignancies with lenalidomide and placebo were 5.2% and 3.5%. Longer follow-up will be of interest with regard to rates of myeloma progression and response to lenalidomide or other immunomodulatory drugs.
Consolidative autologous stem-cell transplantation (SCT) is recommended for most transplant-eligible patients with newly diagnosed peripheral T-cell lymphoma (PTCL) who achieve response to front-line combination chemotherapy. However, the relapse rate remains high after autologous SCT. Shmitz and colleagues conducted a randomized trial of autologous versus allogeneic SCT in PTCL patients (age, 18–60 years) who responded to induction chemotherapy (abstract 7503).
At a median follow-up of 42 months, the 3-year event-free survival (EFS; the primary endpoint) was similar with autologous versus allogeneic SCT (38% and 43%, respectively), as was overall survival (OS; 70% and 57%); EFS and OS were also similar in patients who completed the planned SCT. Autologous SCT remains a standard for PTCL in first remission, thus reserving allogeneic STC for relapsing patients.
R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) is a current standard of care for patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL). Lugtenburg and colleagues conducted the phase III HOVON-Nordic Lymphoma Group trial (abstract 7507) to test intensification of rituximab dosing during induction and previously found no benefit of intensified versus standard-dose rituximab. A second component of the trial randomized 398 patients who achieved complete remission from induction therapy to receive maintenance rituximab or observation.
At a median follow-up of 79.9 months, 5-year disease-free survival (the primary endpoint) was similar with maintenance rituximab versus observation (79% and 74%, respectively), as was 5-year OS (85% and 83%). No clinical DLBCL subgroup showed a benefit from maintenance rituximab. The results thus confirm earlier phase III trials that maintenance rituximab is not indicated for DLBCL patients in complete remission following R-CHOP.