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October 7, 2020
by Arizona University of Health Sciences
Skipping radiation and receiving less chemotherapy may become the new standard of care for some lymphoma patients, according to a recent collaborative study by a Daniel Persky, MD, associate director of clinical investigations at the UArizona Cancer Center, principal investigator from his Lymphoma Clinical Research Team and Professor of Medicine in the Division of Hematology and Oncology at the UArizona College of Medicine-Tucson
The study aimed to improve treatment for patients with diffuse large B-cell lymphoma stage I or II (limited stage), the most common type of non-Hodgkin lymphoma in the United States Non-Hodgkin lymphomas are cancers of lymphocytes, a type of white blood cell that helps protect the body from infection and disease The disorder accounts for almost 40% of non-Hodgkin diagnoses and is usually a rapidly spreading cancer, but is potentially curable
In some cases DLBCL can be treated with a combination of chemotherapy known as R-CHOP This combination consists of five drugs approved by the US Food and Drug Administration (FDA) – rituximab (R) more cyclophosphamide (C), hydroxydaunomycin (H), oncovin (O) and prednisone (P) Patients then undergo three cycles of chemotherapy followed by radiation therapy, or go through six cycles without radiation therapy
In the new study published in July in the Journal of Clinical Oncology, research suggests that radiation therapy is not necessary for many patients Instead, it suggests using a positron emission tomography (PET ) after three cycles of R-CHOP If the patient’s CT scan is negative, they can do one more cycle of R-CHOP to complete their treatment
Dr Persky was the principal investigator of the study conducted by the SWOG Research Network, a cancer clinical trials network funded by the National Cancer Institute.The results showed that 91% of people who received no radiation therapy were alive five years after treatment and 89% were cancer-free
The study shows promise in reducing unintended harmful effects that can be caused by radiation therapy and chemotherapy, such as R-CHOP, in patients These effects are of particular concern in older patients who may be in pain or be at risk other health problems as they get older Therefore, reducing the toxicity of their cancer treatments can have significant health benefits and improve their quality of life.
“We serve this population, and tolerance to treatment is important to them,” Dr Persky said “It is much easier to get an older patient through four cycles of R-CHOP than six. «
“This is very important to many of our patients at the UArizona Cancer Center,” said Joann Sweasy, Phré, the Nancy C and Craig M Berge Endowed Chair and Director of the UArizona Cancer Center “I congratulate Dr. Persky for leading this high impact clinical research study «
In the study, patients with positive PET scans did not perform additional cycles of R-CHOP Instead, they underwent radiation therapy and booster therapy in areas where scans showed rapidly growing cancer cells These patients then received treatment with a radioimmunotherapy drug, ibritumomab tiuxetan, which is not yet FDA approved for DLBCL, but which is approved for other types of lymphoma.
« The provisional positive PET group was for people at greater risk of their cancer having relapsed or recurring, » said Dr Persky said « This group also did very well in the study »
« This may be the new standard of care for patients with late stage DLBCL, » Dr Persky said « Many patients may forgo radiation therapy and receive less chemotherapy while achieving great results. »
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Global news – US – Many non-Hodgkin lymphoma patients may ignore radiation, collaborative study finds
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