Dr. Zelenetz Discusses Treatment Options for DLBCL

Andrew D. Zelenetz, MD, Chief, Lymphoma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Associate Professor of Medicine, Weill Cornell Medical College, discusses improving outcomes and preventing toxicities associated with overtreatment by varying the chemotherapy regimens used for patients with advanced diffuse large B-cell lymphoma (DLBCL).

Zelenetz explains, outcomes can be improved by using the International Prognostic Index (IPI) to select patients that may be more favorable to receive R-CHOP-21 (21-day rituximab-cyclophosphamide-doxorubicin- vincristine-prednisone). Additionally, IPI provides an opportunity to enrich treatment for patients by adjusting their treatment regimen.

Several new chemotherapy combinations are being investigated for patients with DLBCL. Zelenetz notes, one regimen of exceptional importance is the R-EPOCH combination (rituximab-etoposide-prednisone-vincristine-doxorubicin-cyclophosphamide). The phase III trial, CALGB 50303, is currently comparing R-EPOCH to R-CHOP-21 in patients with newly diagnosed DLBCL.

Evidence from the CALGB 50303 study may help determine a correlation between disease response and specific gene expression profiles or signatures. This information allows physicians to make a genomic-based treatment decision.