Key clinical point: Adding rituximab to high-dose methotrexate and temozolomide extends survival in primary central nervous system lymphoma, compared with high-dose methotrexate and temozolomide alone.
Major finding: Patients treated with a combination of rituximab, high-dose methotrexate, and temozolomide had a 5-year overall survival rate of 82.3%, compared with 50.0% when rituximab was excluded from the regimen.
Study details: A retrospective study involving 62 patients with primary central nervous system lymphoma (PCNSL).
Disclosures: The study was funded by the Natural Science Foundation of Guangdong Province. The researchers reported having no conflicts of interest.
Chen C et al. Cancer Med. 2019 Mar 1. doi: 10.1002/cam4.1906.
Dr. David Henry, Editor in Chief of MDedge Hematology/Oncology, comments:
Primary CNS lymphoma (PCNSL) has traditionally been a very difficult entity to treat. The patients are often frail with poor performance status and may not tolerate even the most effective of therapies very well, and PCNSL is usually a high-grade B-cell lymphoma.
Recent nonrandomized studies have explored using methotrexate and temozolomide (MT), both of which penetrate the blood-brain barrier, and these have met with success. Phase 2 studies of rituximab with methotrexate/temozolomide (RMT) have also met been successful, compared with historical controls, even in HIV patients with PCNSL.
In Cancer Medicine, Dr. Cui Chen and colleagues report a retrospective study in Chinese PCNSL patients comparing MT alone to RMT in combination.
Simply put, the results were spectacular, favoring the RMT combination. The study showed significant and striking improvements in both progression-free and overall survival. Future prospective studies are awaited to confirm these studies.
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Global Burden of Brain and Other CNS Cancers, Lancet Neurol; ePub 2019 Feb 20; GBD 2016 Brain and Other CNS Cancer Collaborators