Researchers from Memorial Sloan-Kettering Cancer Center have reported that Nipent (pentostatin), Cytoxan (cyclophosphamide) and Rituxan (rituximab) (PCR) has high activity in previously treated patients with chronic lymphocytic leukemia (CLL) or low-grade non-Hodgkin’s lymphoma (NHL). These results were published in the April 1, 2006, issue of the Journal of Clinical Oncology .

One of the most active drug combinations for the treatment of CLL and low-grade NHL is Fludara® (fludarabine), Cytoxan and Rituxan. The main side effect of this regimen is an increased risk of infection.

The current study substituted Nipent for Fludara for the treatment of previously treated patients with CLL. This trial included 46 patients, 32 with CLL and 14 with low-grade NHL. The median age was 62 years with the oldest patient being 80 years old. The median number of prior chemotherapy regimens was 2 with a range of one to 7. Over 70% of patients received the full protocol-prescribed doses of drugs.

The complete response rate was 25% and the partial response rate was 50%. The response rate in Fludara-resistant patients was 75%. The median time to treatment failure was 17 months. Median survival of patients with CLL was 42 months. All patients with a complete or nodular response were alive at 36 months compared to an estimated 28% survival for the remaining patients. Grade 3-4 neutropenia occurred in half the patients treated. Fever of unknown origin occurred in 28% and 8 patients had pneumonia with one death from progressive pneumonia.

These authors suggested that the outcomes of patients treated with PCR was superior to similar patients treated with Nipent and Cytoxan without Rituxan. They also suggested that when compared to Fludara, Cytoxan and Rituxan patients receiving PCR had less grade 3-4 neutropenia, less infections and received more of the protocol dosing of drugs.

Comments:  These data suggest that Nipent compares well with Fludara for the treatment of CLL and low-grade NHL with possibly less toxicity.

Related news:

Nipent®/Cytoxan®/Rituxan® Shows High Activity in High-Risk Chronic Lymphocytic Leukemia (11/23/2005)

Reduced-Intensity Allogeneic Stem Cell Transplants with Pentostatin and Extracorporeal Photopheresis Promising for Some Patients (11/16/2005)

Reference:  Lamanna N, Kalaycio M, Maslak P, et al. Pentostatin, cyclophosphamide, and rituximab is an active, well-tolerated regimen for patients with previously treated chronic lymphocytic leukemia. Journal of Clinical Oncology . 2006;24:1575-1581.