Cited by 84Lymphoma Diagnosis and TreatmentViral-associated cancers and disordersCNS Lymphoma Diagnosis and Treatment

ROBUST: First report of phase III randomized study of lenalidomide/R‐CHOP (R2‐CHOP) vs placebo/R‐CHOP in previously untreated ABC‐type diffuse large B‐cell lymphoma

Vitolo, U., Witzig, T.E., Gascoyne, R.D., Scott, D.W., Zhang, Q., Jurczak, W., Özcan, M., Hong, X. +21 more·2019·Hematological Oncology

Abstract

Introduction: The activated B-cell-like (ABC) subtype of diffuse large B-cell lymphoma (DLBCL) continues to convey inferior survival despite efforts to enhance outcomes with novel R-CHOP combinations. Phase II studies have suggested that the addition of the immunomodulatory agent lenalidomide to R-CHOP could ameliorate the poor prognostic effect of the ABC phenotype and improve treatment outcome in this subgroup of patients. Methods: The global phase III ROBUST trial (NCT02285062) is the first to compare lenalidomide/R-CHOP (R2-CHOP) vs placebo/R-CHOP in previously untreated, prospectively selected, CD20+ ABC-type DLBCL. Patients included adults with Ann Arbor stage II-IV disease, IPI score ≥ 2, and ECOG PS ≤ 2. Confirmation of histology and cell-of-origin type were prospectively analyzed from formalin-fixed, paraffin-embedded excisional/surgical or core needle biopsy samples by central pathology using the NanoString Lymphoma Subtyping Test (LST), based on the Lymph2Cx GEP assay (Scott, Blood 2014). ABC-DLBCL patients were stratified by IPI score (2 vs ≥ 3), bulky disease (< 7 vs ≥ 7 cm) and age (< 65 vs ≥ 65 y), and randomized 1:1 to lenalidomide PO 15 mg/d, d1-14/21 + standard R-CHOP21 vs placebo/R-CHOP21 for 6 cycles, with 2 additional, optional doses of rituximab per local practice. The primary endpoint was progression-free survival (PFS) assessed by independent central radiology per 2014 NHL IWG criteria, and defined as time from randomization to PD or death from any cause. Results: A total of 570 ABC-DLBCL patients met eligibility criteria and were enrolled in ROBUST (n = 285 per arm). Baseline demographics were similar between arms, with a median age for all patients of 65 y (52% ≥ 65 y), 42% IPI 2 score/58% IPI ≥ 3 score, 88% stage III/IV disease, and 34% bulky disease. The primary endpoint of PFS was not met with an HR = 0.85 (95% CI, 0.63-1.14) and P = 0.29; median PFS was not reached for either arm (Figure). Positive PFS trends favoring R2-CHOP over placebo/R-CHOP were observed with disease stage III/IV (HR = 0.81 [95% CI, 0.60-1.10]) and IPI score ≥ 3 (HR = 0.74 [95% CI, 0.53-1.05]). Median EFS was not reached for either arm (HR = 1.04; 95% CI, 0.80-1.34; P = 0.73). At a median follow-up of 27.1 mo (range, 0-47) for survivors, 2-y OS was 79% for R2-CHOP and 80% for placebo/R-CHOP (medians not reached). ORR was 91% for both arms, with 69% vs 65% CR for R2-CHOP vs placebo/R-CHOP, respectively. 74% R2-CHOP and 84% placebo/R-CHOP patients completed 6 cycles of treatment; AEs (mainly neutropenia) were the most common reason for treatment discontinuation. The most common grade 3/4 AEs (≥ 10%) for R2-CHOP vs placebo/R-CHOP were neutropenia (60% vs 48%), anemia (22% vs 14%), thrombocytopenia (17% vs 11%), leukopenia (14% vs 15%), febrile neutropenia (14% vs 9%), and lymphopenia (11% vs 8%).

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Crossref · 10.1002/hon.5_2629

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Authors
Vitolo, U., Witzig, T. E., Gascoyne, R. D., Scott, D. W., Zhang, Q., Jurczak, W., Özcan, M., Hong, X., Zhu, J., Jin, J., Belada, D., Bergua, J. M., Piazza, F., Mócikova, H., Molinari, A. L., Yoon, D. H., Cavallo, F., Tani, M., Izutsu, K., Kato, K., Czuczman, M., Hersey, S., Kilcoyne, A., Russo, J., Hudak, K., Zhang, J., Chiappella, A., Nowakowski, G. S., & on behalf of the ROBUST study investigators
Affiliations
  • Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT)
  • Mayo Clinic (US)
  • BC Cancer Agency (CA)
  • Harbin Medical University (CN)
  • Jagiellonian University (PL)
  • Ankara University (TR)
  • Fudan University (CN)
  • Peking University Cancer Hospital (CN)
  • First Affiliated Hospital Zhejiang University (CN)
  • Charles University (CZ)
  • Hospital San Pedro de Alcántara (ES)
  • University of Padua (IT)
  • Department of Internal Medicine and Haematology Faculty Hospital Kralovske Vinohrady Prague Czech Republic
  • Ospedale Infermi di Rimini (IT)
  • Asan Medical Center (KR)
  • Ospedale "Santa Maria delle Croci" di Ravenna (IT)
  • National Cancer Center Hospital (JP)
  • Kyushu University (JP)
  • Celgene (United States) (US)
Venue
Hematological Oncology
Publisher
Wiley
Published
2019-06
Volume
37
Issue
S2
Pages
36-37
ISSN
  • 0278-0232 (ISSN-L)
  • 1099-1069
OpenAlex
W2951720456
Cited by
84
References
0
Citations by year
2025: 2 · 2024: 1 · 2023: 2 · 2022: 7 · 2021: 35 · 2020: 25 · 2019: 12
FWCI
14.52
Type
journal article
Language
en
Open access
closed
Locations
Hematological Oncology (publishedVersion)
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Lymphoma Diagnosis and Treatment
  • Health Sciences › Medicine › Oncology › Viral-associated cancers and disorders
  • Health Sciences › Medicine › Neurology › CNS Lymphoma Diagnosis and Treatment
Keywords
ABC-DLBCL, lenalidomide, R-CHOP, previously untreated lymphoma, progression-free survival, immunomodulators, rituximab, cell of origin, IPI risk stratification, bulky disease

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