SALT LAKE CITY, UT – Since the release of the National LymphoCare Study nearly 10 years ago, few studies have described real-world practice patterns and clinical outcomes in patients with follicular lymphoma, including the use of maintenance rituximab therapy in the United States.
Based on that information, a study in Cancer Medicine used data from the largest integrated healthcare system in the United States, the VHA. The research led by the Huntsman Cancer Institute, the University of Utah and the Salt Lake City VAMC identified rates of adoption and effectiveness of maintenance rituximab therapy in FL patients after first-line treatment.1
To do that, the study team identified previously untreated patients with FL in the VHA between 2006 and 2014 who achieved at-least stable disease after chemoimmunotherapy or immunotherapy. Classified as the MR group were patients who initiated maintenance rituximab therapy within 238 days of first line treatment; those who did not were classified as the non-MR group.
With 676 patients meeting inclusion criteria, including 300 receiving MR, researchers examined the effect of MR on progression-free survival (PFS) and overall survival (OS).
Results indicated that MR was associated with significant PFS (hazard ratio [HR]=0.55, P < .001) and OS (HR = 0.53, P = .005) compared to the non-MR group, after adjusting by age, sex, ethnicity, geographic region, diagnosis period, stage, grade at diagnosis, hemoglobin, lactate dehydrogenase (LDH), Charlson comorbidity index (CCI), first line treatment regimen, and response to first line treatment.
“These results suggest that in FL patients who do not experience disease progression after 1L treatment in real-world settings, MR is associated with a significant improvement in both PFS and OS,” the authors wrote. “Maintenance therapy should be considered in FL patients who successfully complete and respond to 1L therapy.”
“The results of this real‐world study suggest that MR after the completion of 1L treatment is not commonly adopted in veterans with FL, and there has been little to no increase in adoption over time,” researchers concluded. “Patients who achieve a partial response to 1L treatment are more likely to receive MR. Our study joins two other studies of FL in real‐world settings and one meta‐analysis of clinical trial evidence, suggesting that MR is associated with an increase in OS in FL patients.”
They urged physicians to incorporate the findings instead of relying exclusively on any one study when recommending whether a patient should receive MR after the completion of first line treatment. “Based on our study, maintenance therapy after 1L treatment in FL should be considered, especially in those patients who may not be as young or fit as those reported in clinical trials,” the authors emphasized.
- Halwani AS, Rasmussen KM, Patil V, et al. Maintenance rituximab in Veterans with follicular lymphoma [published online ahead of print, 2020 Aug 28]. Cancer Med. 2020;10.1002/cam4.3420. doi:10.1002/cam4.3420