KEY TAKEAWAYS
- The REMoDL-B phase III adaptive trial compared R-CHOP versus RB-CHOP in patients with DLBCL stratified by molecular subtype.
- The primary aim was to assess the effect of bortezomib on PFS and OS.
- Retrospective analysis using a gene expression-based classifier was conducted to identify the MHG group with worse outcomes.
- At a median follow-up of 64 months, there was no overall benefit of bortezomib on PFS or OS.
- Improved PFS and OS were seen in ABC lymphomas after RB-CHOP, and higher PFS in MHG lymphomas.
- Patients with ABC and MHG DLBCL may benefit from adding bortezomib to R-CHOP in initial therapy.
The REMoDL-B phase III adaptive trial compared conventional R-CHOP therapy to standard R-CHOP + bortezomib (RB-CHOP) therapy in patients with diffuse large B-cell lymphoma (DLBCL), stratified by molecular subtype. The preliminary research showed no significant improvement in PFS or OS with bortezomib, with a median follow-up of 30 months. Based on gene expression analysis, a retrospective investigation identified a subset of molecular high-grade (MHG) cases with poor outcomes.
The researchers presented an updated statistical analysis of patients successfully classified by gene expression profile (GEP). Patients with DLBCL, GEP-appropriate biopsies, and the ability to take full-dose chemotherapy were eligible for this study. Among the 1,077 people, 801 were diagnosed with a kind of lymphoma known as Activated B-cells (ABC), germinal center B cells (GCB), or minor histiocytic (MHG). Hazard ratio (HR) for bortezomib’s effect on progression-free survival (PFS) at 5 years: 0.81; P =.085; OS HR: 0.86; P =.32; median follow-up: 64 months. PFS and OS were enhanced after RB-CHOP in ABC lymphomas, whereas they were impaired after R-CHOP. The 5-year OS was 67% with R-CHOP and 80% with RB-CHOP (HR, 0.58; 95% CI, 0.35 to 0.95; P =.032). MHG lymphomas had a more significant PFS (29%) than HL (55%) at five years (HR, 0.46; 95% CI, 0.26 to 0.84). Initiating therapy with bortezomib in addition to R-CHOP for patients with ABC and MHG DLBCL may be beneficial.
Source: https://pubmed.ncbi.nlm.nih.gov/36972491/
Clinical Trial: https://clinicaltrials.gov/ct2/show/NCT01324596
Davies AJ, Barrans S, Stanton L, Caddy J, Wilding S, Saunders G, Mamot C, Novak U, McMillan A, Fields P, Collins GP, Stephens R, Cucco F, Sha C, van Hoppe M, Tooze R, Davies JR, Griffiths G, Schuh A, Burton C, Westhead DR, Du MQ, Johnson PWM. Differential Efficacy From the Addition of Bortezomib to R-CHOP in Diffuse Large B-Cell Lymphoma According to the Molecular Subgroup in the REMoDL-B Study With a 5-Year Follow-Up. J Clin Oncol. 2023 Mar 27:JCO2300033. doi: 10.1200/JCO.23.00033. Epub ahead of print. PMID: 36972491.
