Lenalidomide plus cyclophosphamide, doxorubicin, vincristine, prednisone and rituximab is safe and effective in untreated, elderly patients with diffuse large B-cell lymphoma: a phase I study by the Fondazione Italiana Linfomi

Abstract

Despite improvements in standard therapy with rituximab-cyclophosphamide-doxorubicin- vincristine-prednisone scheme for patients with untreated, diffuse large-B-cell lymphoma up to 40% relapse. Lenalidomide alone or in combination with rituximab showed activity in relapsed/refractory aggressive lymphomas. In this phase I study we determined the maximum tolerated dose of lenalidomide plus rituximab-cyclophosphamide-doxorubicin-vincristine- prednisone in untreated elderly (median age 68 years) patients with diffuse large-B-cell lymphoma. Four lenalidomide doses (5, 10, 15, and 20 mg/day on days 1-14) allocated using the continual reassessment method were planned to be administered for 14 days in combination with each course of rituximab-cyclophosphamide-doxorubicin-vincristine-prednisone for a total of six courses. Seven patient cohorts (n=3 each) were treated (total n=21) at 10, 20, 15, 15, 15, 10, and 10 mg of lenalidomide. Dose-limiting toxicities occurred in seven patients during the first three treatment courses. The third dose-level of lenalidomide (15 mg/day) was selected as the maximum tolerated dose, with an estimated dose-limiting toxicities probability of 0.345 (95% credibility interval 0.164-0.553). Grade 3-4 hematologic adverse events were: neutropenia in 28% of the courses, thrombocytopenia in 9%, and anemia in 3%. Non-hematologic toxicities were moderate: grade 4 increase of creatinine phosphokinase (n=1), grade 3 cardiac (n=2), grade 3 neurologic (n=3), and grade 3 gastrointestinal (n=1). In this phase I study, 90% of patients achieved an overall response with 81% achieving complete remission. This combination regimen appears safe in elderly patients with diffuse large-B-cell lymphoma and its efficacy will be assessed in the ongoing phase II trial. This trial was registered at www.clinicaltrials.gov as NCT00907348