Risk-adapted therapy approach with dose-adjusted etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, and rituximab (DA-EPOCH-R) is an effective and well tolerated treatment for Burkitt lymphoma, according to a study published in the Journal of Clinical Oncology.
Treatment of Burkitt lymphoma is often limited by treatment-associated toxicities, especially in vulnerable patients, such as those with HIV or with advanced age.
In this multicenter, phase 2 trial (ClinicalTrials.gov Identifier: NCT01092182), patients with untreated Burkitt lymphoma received treatment on a risk-stratified basis and event-free survival (EFS) was the primary study endpoint.
Patients who were considered high risk, based on multiple factors, were treated with DA-EPOCH-R for 6 cycles, in addition to intrathecal methotrexate. Low-risk patients received 2 cycles of DA-EPOCH-R with additional rituximab (DA-EPOCH-RR), after which they were evaluated by positron emission tomography (PET).
PET results guided additional treatment for low-risk patients. Patients with negative PET results received 1 more cycle of DA-EPOCH-RR, while patients with positive PET results received 4 cycles of DA-EPOCH-R with intrathecal methotrexate.
Of 113 evaluated patients (median age, 49 years), 87% were considered high risk, 25% tested positive for HIV, 10% had cerebrospinal fluid (CSF) involvement, and 25% had peripheral blood and/or bone marrow involvement.
The median study follow-up was at 58.7 months. For all patients, the 4-year EFS rate was 84.5%, and the 4-year overall survival rate was 87.0%; 4-year EFS rates for low-risk and high-risk patients was 100% and 82.1%, respectively. The study investigators reported that efficacy did not significantly differ based on patient age, International Prognostic Index score, or HIV status.
In this analysis, CSF involvement was linked to greater risks of treatment failure or toxicity-associated death. The investigators reported 14 deaths, 5 of which were considered related to treatment. Tumor lysis syndrome occurred in 5% of patients.
“In conclusion, risk-adapted DA-EPOCH-R is highly effective in adults with Burkitt lymphoma irrespective of HIV status, and its relative tolerance allows broad applicability across patients of all ages,” the study investigators wrote in their report.
Roschewski M, Dunleavy K, Abramson J, et al. Multicenter study of risk-adapted therapy with dose-adjusted EPOCH-R in adults with untreated Burkitt lymphoma [published online May 26, 2020]. J Clin Oncol. doi: 10.1200/JCO.20.00303