Etoposide is a feasible and well-tolerated alternative for doxorubicin in standard chemotherapy protocols in patients with diffuse large B-cell lymphoma (DLBCL) who cannot be treated with anthracyclines, researchers have concluded.

“For patients who are not candidates for anthracyclines, a key component in R-CHOP, R-CEOP represents a valid alternative that can be used in clinical practice and is associated with encouraging efficacy and cure in a substantial proportion of patients,” senior study author Prof Laurie Sehn, of the University of British Columbia, told the limbic.

In a study of 70 patients with newly diagnosed disease treated with R-CEOP, there was no significant difference in 10-year time to progression or disease-specific survival compared with 140 case-matched controls who had the standard R-CHOP regimen.

The 10-year overall survival was lower in the R-CEOP group (30% vs 49%) but this reflected the impact of underlying comorbidities and frailty of this group of patients, the Canadian researchers concluded in their paper in Blood Advances. 

Overall, the study showed that R-CEOP was a useful treatment alternative in patients in whom doxorubicin was contraindicated because of a pre-existing cardiac condition, other comorbidities, or because they had previously been treated with an anthracycline for another cancer.

Because most patients with DLBCL were older when diagnosed, a substantial number were not candidates for the standard R-CHOP regimen because of these other health issues. But etoposide has proven efficacy in non-Hodgkin lymphoma and importantly does not induce cardiac toxicity, the researchers said.

In all, 90% of the patients receiving R-CEOP in the study had a cardiac contraindication.

Some patients on the alternative regimen did receive partial treatment with anthracyclines but they appeared to have a similar outcome compared with those who received no anthracycline therapy at all.

While the study was not powered to definitively compare the efficacy of the two treatment options, after a median follow-up of more than 12 years, long-term disease control with R-CEOP was relatively high “suggesting that a significant proportion of patients may be cured by this combination,” the researchers concluded.

“The availability of an alternative regimen with curative potential in patients who cannot receive the current standard of care is important, as these patients represent an ongoing challenge frequently encountered in clinical practice,” Prof Sehn said.