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A recent meta-analysis of phase 3 randomized controlled trials of front-line treatments for follicular lymphoma evaluated progression-free survival (PFS) outcomes for multiple therapies. Results of this study were presented at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago, Illinois.
Data included in this Bayesian random-effects network meta-analysis came from BRIGHT (ClinicalTrials.gov Identifier: NCT00877006), FOLL05 (ClinicalTrials.gov Identifier: NCT00774826), GALLIUM (ClinicalTrials.gov Identifier: NCT01332968), PRIMA (ClinicalTrials.gov Identifier: NCT00140582), RELEVANCE (ClinicalTrials.gov Identifier: NCT01476787), StiL NHL1 (ClinicalTrials.gov Identifier: NCT00991211), and StiL NHL7 (ClinicalTrials.gov Identifier: NCT00877214) studies. PFS outcomes with 11 therapy regimens were examined for pairwise comparisons.
Several of the pairwise comparisons involved 1 of 2 reference treatment protocols. These were rituximab plus bendamustine (R-Benda) and the combination of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone with 2 years of rituximab maintenance (R-CHOP-R).
The treatment strategy showing the greatest PFS benefit was obinutuzumab plus bendamustine with 2 years of obinutuzumab maintenance (G-Benda-G). G-Benda-G showed a hazard ratio (HR) of 0.62 (95% CI, 0.55-0.77) in comparison with R-Benda and an HR of 0.65 (95% CI, 0.59-0.77) when compared with R-CHOP-R.
Treatment with R-Benda with rituximab maintenance for 4 years (R-Benda-R4) or for 2 years (R-Benda-R) were also superior to both R-Benda and R-CHOP-R in this analysis.
G-Benda-G outperformed R-Benda-R (HR, 0.82; 95% CI, 0.75-0.97), though G-Benda-G performed similarly to R-Benda-R4 (HR, 0.94; 95% CI, 0.78-1.09).
R-Benda and R-CHOP-R performed similarly to each other. Several treatment regimens demonstrated similar or inferior PFS rates in comparison with R-Benda or R-CHOP-R.
Rituximab plus lenalidomide with 2 years of rituximab maintenance (R-Len-R) was also evaluated. R-Len-R performed similarly to both R-Benda (HR, 0.97; 95% CI, 0.83-1.14) and R-CHOP-R (HR, 1.01; 95% CI, 0.88-1.14).
In advanced follicular lymphoma, this meta-analysis indicated that G-CHOP-G, R-Benda-R4, and R-Benda-R imparted the greatest PFS benefits in the included phase 3 trials.
- Wang Y, Zhou S, Yang F, et al. Efficacy of frontline treatment regimens in follicular lymphoma: A network meta-analysis of phase III randomized controlled trials. Poster presentation at: 2019 ASCO Annual Meeting; June 3, 2019; Chicago, IL. Abstract 7556.