A treatment combination including Velcade (bortezomib) was seen to be more effective than the standard R-CHOP chemotherapy in East Asian patients with mantle cell lymphoma (MCL) who cannot undergo a stem cell transplant, according to researchers.
Their study, “Bortezomib-based therapy for transplant-ineligible East Asian patients with newly diagnosed mantle-cell lymphoma,” appeared in the journal OncoTargets and Therapy.
In East Asian patients, evidence supporting the effectiveness of MCL treatment with a combination of Rituxan (rituximab, by Genentech and Biogen) and chemotherapy — called R-CHOP — is still limited.
R-CHOP was considered the standard front-line therapy for patients for whom intensive chemotherapy and stem cell transplant are not options.
However, the international LYM-3002 Phase 3 trial (NCT00722137) in stem cell transplant-ineligible patients showed that using Velcade instead of the R-CHOP component vincristine — a combo approach called VR-CAP — improved survival outcomes.
Despite these data, no studies had specifically explored the safety and effectiveness of Velcade in East Asian patients with MCL, the authors said.
Such an assessment would be important, as the effects of anti-cancer medications could vary markedly between Western and Asian patients, resulting in different doses, they wrote.
The scientists conducted a subgroup analysis of patients participating in the LYM-3002 trial to assess the efficacy and safety of VR-CAP vs. R-CHOP in East Asian patients — from China, Japan, South Korea, and Taiwan — with a new diagnosis of MCL and who are ineligible for a stem cell transplant.
The trial included a total of 121 patients with stage 2 or 3 MCL, who received six to eight cycles of either R-CHOP or VR-CAP.
After a median follow-up of 42.4 months, treatment with VR-CAP improved the time a patient lived without disease worsening by 43%, a finding consistent with data from the overall patient group included in the LYM-3002 study.
VR-CAP also resulted in a superior complete response rate compared to R-CHOP (63% vs. 47%) and duration (46.7 vs. 16.6 months), as well as longer median treatment-free interval (46.5 vs. 21 months).
VR-CAP-associated toxicity was higher than R-CHOP, but manageable, as it did not affect the number of completed cycles or median dose intensity. These findings also reflected those found in the overall LYM-3002 participants, the investigators said.
The most common adverse events were reduced platelet counts, anemia, low levels of lymphocytes, diarrhea, fever, and nausea.
Overall, “these findings suggest that VR-CAP is a feasible and active treatment option in East Asian patients with MCL who are ineligible for transplant,” the researchers wrote.
However, they cautioned that because most patients analyzed were of Chinese ethnicity (79%), “the results presented here may be more representative of the efficacy and safety of VR-CAP and R-CHOP in Chinese patients.”
