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Bendamustine-Rituximab Shines in Frontline Treatment of MCL, iNHL

Key clinical point: Long term follow-up data confirm bendamustine plus rituximab as a frontline treatment option for mantle cell and indolent lymphomas.

Major finding: The 5-year progression-free survival rates were 65.5% for bendamustine plus rituximab and 55.8% for rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or with cyclophosphamide, vincristine, and prednisone (R-CVP).

Study details: A 5-year follow-up of the BRIGHT study evaluating different treatment regimens in treatment-naive patients with indolent non-Hodgkin lymphoma or mantle cell lymphoma. There were 447 patients in the intention-to-treat population.

Disclosures: The study was supported by Teva Pharmaceuticals. Dr. Flinn reported institutional research funding from Teva.; she also received institutional research funding from and served as a consultant to several other companies.

Citation:

Flinn IW et al. J Clin Oncol. 2019 Feb 27. doi: 10.1200/JCO.18.00605.

Commentary:

Dr. David Henry, Editor in Chief of MDedge Hematology/Oncology, comments:

The authors report some results from the BRIGHT study, which gave frontline therapy to mantle cell and indolent non-Hodgkin lymphoma patients randomizing between bendamustine/rituximab (BR) or R-CHOP or R-CVP. The 5-year progression-free survival rates were superior with BR, although there was no significant difference in overall survival. The complete response rates among the treatment arms were not different, but the 5-year progression-free survival rates were 65.5% in the BR group and only 55.8% in the R-CHOP/R-CVP group, for a hazard ratio of 0.61 (P= .0025). Event-free survival was similarly better in the BR group.

The authors conclude that of the three therapies, they all are quite effective and none is better than the other regarding overall survival, probably because this disease carries such a long course and multiple therapies can work. However, the upfront use of BR might be associated with a more attractive progression-free survival for patients undergoing therapy and is certainly well tolerated.