New drugs are continually being researched and developed for Non-Hodgkin’s lymphoma. These must be shown to be safe and effective before doctors can prescribe them to patients. Through clinical trials, researchers test the effects of new drugs on a group of volunteers with non-Hodgkin’s lymphoma. Following a strict protocol and using carefully controlled conditions, researchers evaluate the investigational drugs under development and measure the ability of the new drug to treat non-Hodgkin’s lymphoma,...
Standard Treatment Options for Aggressive, Stage I and Contiguous Stage II Adult NHL
Standard treatment options for aggressive, stage I and contiguous stage II adult NHL include the following:
R-CHOP with or without IF-XRT.
R-CHOP with or without IF-XRT
Four prospective randomized trials have evaluated the comparison of CHOP or more intensive CHOP-based chemotherapy alone versus combined–modality therapy with CHOP and IF-XRT.[1,2,3,4,5]
Evidence (CHOP vs. CHOP with IF-XRT):
In a randomized trial with 7 years' median follow-up, 576 patients older than 60 years with early-stage disease received four cycles of CHOP with or without IF-XRT; there was no difference in 5-year event-free survival (EFS) (61% vs. 64%, P = .5) or overall survival (OS) (72% vs. 68%, P = .6).[Level of evidence: 1iiA]
A randomized trial of 401 patients comparing eight cycles of CHOP to three cycles of CHOP with IF-XRT was initially reported as having an OS advantage for the combined–modality arm at 5 years, but a re-evaluation for OS at 9 years showed no difference in either arm of the study.[Level of evidence: 1iiA]
A randomized study (EST-1484) of 210 patients who attained a radiologic complete remission after eight cycles of CHOP compared IF-XRT with no further therapy; there was no difference in OS at 10 years (68% vs. 65%, P = .24).[Level of evidence: 1iiA]
A randomized trial of 631 patients younger than 60 years compared more intensive CHOP-based chemotherapy versus three cycles of CHOP with IF-XRT; with 4 years' median follow-up, the intensive chemotherapy was superior in 5-year EFS (82% vs. 74%, P > .001) and 5-year OS (90% vs. 81%, P = .001).[Level of evidence: 1iiA]
The confirmation of efficacy for rituximab in advanced-stage disease as evidenced in SWOG-S0014 (NCT00005089), for example, has suggested the use of R-CHOP with or without radiation therapy but its use is only supported by retrospective comparisons.[Level of evidence: 3iiiDiii]
R-CHOP (rituximab + cyclophosphamide + doxorubicin + vincristine + prednisone); four to six cycles.