According to the long-term data of a clinical trial published in the Journal of Clinical Oncology, first-line whole-brain radiotherapy (WBRT) demonstrated suboptimal efficacy in reducing relapses and was associated with increased neurotoxicity compared with autologous stem-cell transplantation (ASCT) in patients with primary central nervous system (CNS) lymphoma.1

The researchers previously reported the results of a randomized phase 2 study (ClinicalTrials.gov Identifier: NCT00863460) in which patients with newly diagnosed primary CNS lymphoma (18-60 years) were treated with high-dose methotrexate-based induction chemotherapy followed by WBRT (40 Gy) or high-dose chemotherapy (thiotepa-busulfan-cyclophosphamide; TBC) with ASCT (median follow-up duration, 33 months).2

“The initial report of the PRECIS trial delineated an important rate of failure of induction chemotherapy, a better disease control with TBC-ASCT consolidation, and an overt risk of cognitive impairment early after receiving conventional WBRT consolidation,” according to the researchers.


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In the update, the team evaluated long-term (median follow-up duration, 8 years) outcomes and toxicities of the treatments.1 Of the 66 patients who initiated treatment in each study arm, 53 and 44 patients who received induction chemotherapy followed by WBRT or ASCT, respectively, were included in the long-term analysis.

The investigators reported that the 8-year event-free survival rate was 67% and 39% in the ASCT and WBRT arms, respectively (P =.03) and found that patients had a significantly lower risk of relapse after ASCT (hazard ratio, 0.13; P <.001).

Following salvage treatment, 8 patients who relapsed after WBRT (7 of whom received ASCT at relapse) were alive and disease free at the last follow up. ASCT and WBRT-related toxicities resulted in the death of 5 and 4 patients, respectively.

The team reported that the 8-year overall survival rates were not significantly difference between the arms (69% and 65% in the ASCT and WBRT arms, respectively).

They also observed that patients in the WBRT arm experienced significantly more balance (52% vs 10%; P ≤.001) and neurocognition (64% vs 13%; P <.001) deterioration than those in the ASCT arm during the follow up.

“In conclusion, the long-term analysis of the PRECIS trial confirms that conventional 40 Gy WBRT should be avoided in first-line treatment because of its neurotoxicity and suboptimal efficacy in reducing relapses, and favors ASCT consolidation in first-line treatment for a better disease control,” the researchers wrote in their report.

Disclosure: This research was supported by Roche, Amgen, and Pierre Fabre. Please see the original reference for a full list of disclosures.

References

  1. Houillier C, Dureau S, Taillandier L, et al. Radiotherapy or autologous stem-cell transplantation for primary cns lymphoma in patients age 60 years and younger: long-term results of the randomized phase II PRECIS study. Published online July 14, 2022. J Clin Oncol. doi:10.1200/JCO.22.00491
  2. Houillier C, Taillandier L, Dureau S, et al. Radiotherapy or autologous stem-cell transplantation for primary cns lymphoma in patients 60 years of age and younger: results of the intergroup ANOCEF-GOELAMS randomized phase II PRECIS study. J Clin Oncol. 2019;37(10):823-833. doi:10.1200/JCO.18.00306