Researchers from the M.D. Anderson Cancer Center have reported that the combination of gemcitabine, rituximab, oxaliplatin, and pegfilgrastim compares favorably with other salvage regimens for relapsed non-Hodgkin’s lymphoma (NHL) and is less toxic. The details of this study were presented at the 2008 meeting of the American Society of Clinical Oncology in Chicago May 30-June 2.¹

Autologous stem cell transplantation (ASCT) is the most effective treatment for patients with NHL who have failed primary therapy. However, many patients are not considered candidates due to age or significant co-morbid conditions. The usual regimens for such re-induction attempts prior to ASCT or for conventional therapy include DHAP (dexamethasone, cytarabine, and cisplatin), ESHAP (etoposide, solumedrol, cytarabine, cisplatin), and RICE (rituximab, ifosfamide, carboplatin, etoposide). The addition of rituximab to these regimens appears to improve outcomes. Gemcitabine-based regimens have also been found to be effective for treatment of patients with NHL who have relapsed or are refractory. Oxaliplatin is also an active agent for the treatment of failed NHL.

At ASCO 2008 researchers from M.D. Anderson Cancer Center presented data on 37 patients with relapsed aggressive NHL treated with gemcitabine, rituximab, oxaliplatin (GROC) and pegfilgrastim given every 14 days. The results were compared with other salvage regimens as shown in the following table:

These results are apparently for patients not proceeding to ASCT. These authors also reported that 16 patients had a longer progression-free survival after GROC than after initial therapy. These authors concluded that GROC was as effective as the other commonly used salvage therapies with less hematologic and non-hematologic toxicities.

Comments: It would appear that GROC is a reasonable re-induction regimen for patients with NHL who fail primary therapy. This regimen should receive more study, especially in patients scheduled for ASCT where toxicity of the induction regimen is a major issue.

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(6/5/2003)

Reference:

¹ Cabanillas F, Liboy I, Rodriguez-Monge E, et al. GROC (gemcitabine, rituximab, oxaliplatin combination) plus pegfilgrastim is less toxic and as active as DHAP and ESHAP for relapsed aggressive non-Hodgkin’s lymphoma (NHL). Journal of Clinical Oncology. 2008;26:abstract 8530.