Skip to Navigation Skip to Search Skip to Content
Search All Centers

DLBCL Treatment Research: Moving Beyond R-CHOP

Read Transcript
View next

Published on July 17, 2020

Since 1976, CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) therapy has been the first-line treatment for diffuse b-cell lymphoma, an aggressive form of non-Hodgkin lymphoma. Expert Dr. Jason Westin says, “although R-CHOP is able to cure a majority of patients, it doesn't cure everybody and it's toxic.” Have researchers found new and better ways to treat DLBCL? Are there other options for newly diagnosed patients besides chemotherapy?
 
Dr. Westin, a leading lymphoma specialist at The University of Texas MD Anderson Cancer Center, discusses clinical trial research on alternative approaches with more targeted agents. He also shares data from the Smart Start trial, which looked at responses from combining three targeted drugs with and without chemotherapy in the non-germinal center subtype of DLBCL.
 

Featuring

Transcript | DLBCL Treatment Research: Moving Beyond R-CHOP

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Hello and welcome to Patient Power. I'm Andrew Schorr. We're visiting with Dr. Jason Westin, who is a researcher and a specialist in lymphoma and specifically aggressive non-Hodgkin lymphomas at MD Anderson Cancer Center in Houston. Dr. Westin, I know that so many patients do well with what's been a standard for a long time now, rituximab (Rituxan) and chemotherapy agents, R-CHOP, but you're researching whether some of these newly diagnosed patients can even do better. Where are we with that related to clinical trials?

Dr. Westin:

It's a great question Andrew because R-CHOP although it is able to cure a majority of patients, it doesn't cure everybody and it's toxic. That's 1970s chemotherapy. The original paper for CHOP was from MD Anderson, published in 1976 and we use the same doses today.

I don't know any other part of our lives that we're still using the same technology. We don't have the same TVs or same phones or same cars. If you have a life-threatening cancer, I'm not sure you'd say, "Can I please have something from 1976 to try and cure me of this disease?" And it's not for lack of effort, there've been Herculean efforts from many of my colleagues over the past decades to try and improve upon that, but it's been a tough nut to crack and that R-CHOP is effective, adding new drugs to R-CHOP has not been effective. There have been many trials of trying to do so-called plus X, R-CHOP plus another new targeted agent. R-CHOP plus something that has a biologic rationale of targeting specific abnormality of the cancer.

Unfortunately, none of those trials, and there have been many, have shown a statistically significant improvement in the cure rate, and the progression free the survival. So my team at MD Anderson has developed some novel clinical trials instead of taking a novel drug and throwing it on the back of 1976 chemotherapy, we've taken the approach of combining novel drugs with each other, the so-called X plus Y approach of taking several drugs, which we think have synergy in the lab, as well as in previous patients that have had relapsed disease and trying this in patients who are newly diagnosed.

And at the ASH 2019 meeting, I presented an update on our trial called the Smart Start Trial, which is combining three targeted drugs upfront, Rituxan, a drug called lenalidomide (Revlimid), and a drug called ibrutinib (Imbruvica) prior to chemotherapy, and a subtype of newly diagnosed diffuse large B-Cell lymphoma. And without a drop of chemo, we found a response rate of 86%. When we combine that with chemotherapy, the response rate at the end was 100% and this subtype is not a good subtype of diffuse large B-Cell lymphoma, the so-called non germinal center subtype.

So that is not something that I would advise people to do off of the clinical trial. Combinations of drugs can be dangerous or toxic if not done with good safety data or under the management of a clinical trial team. But I mentioned the Smart Start clinical trial as hope that we can get beyond the R-CHOP paradigm. It's going to be 50 years old in a couple of years here, we got to do better. We've got to continue to advance and not accept a therapy that cures most patients, maybe two thirds of patients. What about the other third?

And we've got to get smarter and use these new drugs we've got. So I would encourage anybody who's newly diagnosed with diffuse large B-Cell lymphoma to ask your doctor, are there any clinical trials that I could be considered for? And if the answer is no, I'd say, why not? Or could I get a second opinion from somebody at a clinical trial center to consider how I could potentially benefit from a new agent or a new combination of agents to try and get into the 21st century for how we treat this disease?

Andrew Schorr:

Well, thank you for saying that and having been in a clinical trial at MD Anderson, it actually led to a very long remission for me with a leukemia. So I would heartily, I endorse patients going the extra mile to see what is the full range of options for them, including innovative clinical trials. Thanks for the research you're leading Doctor. And I really appreciate you being with us. Dr. Jason Westin from MD Anderson. Thank you.

Dr. Westin:

Thank you. It's my pleasure.

Andrew Schorr:

I'm Andrew Schorr. Remember knowledge and being an advocate for your care or your loved ones can be the best medicine of all.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Recommended for You

View next