Different safety profiles of first-line bendamustine-rituximab (BR), R-CHOP, and R-CVP in an open-label, randomized study of indolent non-Hodgkin lymphoma (NHL) and mantle cell lymphoma (MCL): The BRIGHT study.

Authors

null

David MacDonald

Dalhousie University, Halifax, NS, Canada

David MacDonald , Richard van der Jagt , John M. Burke , Brad S. Kahl , Peter Wood , Tim E. Hawkins , Mark Hertzberg , Yiu-Lam Kwan , David Simpson , Michael Craig , Kathryn S. Kolibaba , Samar Issa , Regina Clementi , Doreen M. Hallman , Mihaela C. Munteanu , Ling Chen , Ian Flinn

Organizations

Dalhousie University, Halifax, NS, Canada, University of Ottawa, Ottawa, ON, Canada, Rocky Mountain Cancer Centers, Aurora, CO, University of Wisconsin Carbone Cancer Center, Madison, WI, Princess Alexandra Hospital, Woolloongabba, Australia, Auckland Hospital, Auckland, New Zealand, Westmead Hospital, Wentworthville, Australia, Concord Repatriation General Hospital, Concord West, NSW, Australia, North Shore Hospital, Takapuna, New Zealand, West Virginia University, Morgantown, WV, Compass Oncology, Vancouver, WA, Middlemore Hospital, Auckland, New Zealand, Teva Pharmaceuticals, Inc., Frazer, PA, Sarah Cannon Research Institute, Nashville, TN

Research Funding

Pharmaceutical/Biotech Company

Background: The BRIGHT study demonstrated that first-line BR was non-inferior to R-CHOP/R-CVP in terms of complete remission rate in indolent NHL and MCL. This is the first detailed analysis of the safety and tolerability of the study regimens. Methods: Patients were preselected for R-CHOP or R-CVP, and then randomized to 6-8 cycles of BR (28-d cycle) or the preselected standard regimen (21-d cycles). BR dosing was bendamustine 90 mg/m2/d as a 30-min infusion on days 1 and 2 plus rituximab 375 mg/m2given before bendamustine on day 1. Colony stimulating factors (CSFs) and antiemetics were given per local standards. Results: In patients preselected for R-CHOP, 103 received BR and 98 R-CHOP. In patients preselected for R-CVP, 118 received BR and 116 R-CVP. For all regimens, ≥ 88% of patients received the planned 6 cycles. Main differences in adverse events (AEs), all grades, are shown in the Table. Incidence of grade 3/4 AEs was 69% for R-CHOP vs 56% BR, and 50% for R-CVP vs 56% BR. Grade 3/4 drug hypersensitivity, neuropathy, and rash were infrequent. Antiemetic use was similar between groups except use of aprepitant as an adjunct to 5-HT3 antagonists was higher with R-CHOP (23% [19% in cycle 1]) than BR (9% [2%]) or R-CVP (3% [2%]). CSF use was higher with R-CHOP (61%) than BR (29%) or R-CVP (27%). Analyses of event prevalence over the treatment period and by region will also be presented. Conclusions: BR, R-CHOP, and R-CVP have significantly distinct AE profiles. More nausea, vomiting, and hypersensitivity occurred with BR while more constipation, neuropathy, and alopecia occurred with RECHOP/R-CVP. Support: Teva BPP R&D, Inc. Clinical trial information: NCT00877006.

All-grade AEs.
Preselected for R-CHOP
Preselected for R-CVP
BR
(n = 103)
%
R-CHOP
(n = 98)
%
BR
(n = 118)
%
R-CVP
(n = 116)
%
Nausea 63 58 63 39
Vomiting 29 13 * 25 13 *
Constipation 32 40 27 44 *
Drug hypersensitivity a 17 6 * 13 3 *
Infection a 55 57 53 50
Grade ≥3 infection 12 5 7 7
Opportunistic infection a 10 7 12 9
Pneumonia / respiratory infection a 18 14 14 13
Peripheral neuropathy / paresthesia a 9 44 14 47
Rash / urticaria a 20 12 24 16
Alopecia 4 51 3 21

a From multiple preferred terms. * P <0.05; P <0.005.

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Abstract Details

Meeting

2013 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Lymphoma and Plasma Cell Disorders

Track

Hematologic Malignancies—Lymphoma and Chronic Lymphocytic Leukemia

Sub Track

Lymphoma

Clinical Trial Registration Number

NCT00877006

Citation

J Clin Oncol 31, 2013 (suppl; abstr 8565)

DOI

10.1200/jco.2013.31.15_suppl.8565

Abstract #

8565

Poster Bd #

49D

Abstract Disclosures