Randomized Phase III Trial Evaluating Subcutaneous Rituximab for the First-Line Treatment of Low–Tumor Burden Follicular Lymphoma: Results of a LYSA Study - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue Journal of Clinical Oncology Année : 2023

Randomized Phase III Trial Evaluating Subcutaneous Rituximab for the First-Line Treatment of Low–Tumor Burden Follicular Lymphoma: Results of a LYSA Study

Emmanuel Bachy
Nicolas Daguindau
  • Fonction : Auteur
Gian-Matteo Pica
  • Fonction : Auteur
Fontanet Bijou
Christiane Mounier
  • Fonction : Auteur
Aline Clavert
  • Fonction : Auteur
Gandhi Laurent Damaj
Borhane Slama
  • Fonction : Auteur
Olivier Casasnovas
Krimo Bouabdallah
  • Fonction : Auteur
David Sibon
Olivier Fitoussi
  • Fonction : Auteur
Nadine Morineau
Charles Herbaux
Thomas Gastinne
  • Fonction : Auteur
Luc-Matthieu Fornecker
Corinne Haioun
  • Fonction : Auteur
Vincent Launay
Carla Araujo
  • Fonction : Auteur
Omar Benbrahim
  • Fonction : Auteur
Laurence Sanhes
Remy Gressin
  • Fonction : Auteur
Hugo Gonzalez
David Ternant
  • Fonction : Auteur
Luc Xerri
  • Fonction : Auteur
Delphine Pranger
  • Fonction : Auteur

Résumé

PURPOSE: Rituximab improves progression-free survival (PFS) and time to next treatment (TTNT) when compared with the watch and wait strategy for patients with low–tumor burden follicular lymphoma (FL). Prolonged rituximab maintenance did not prolong TTNT, whereas it raises concerns about resources use and patient adhesion. Our aim was then to investigate the use of short rituximab maintenance using the subcutaneous (SC) route in patients with low–tumor burden FL.METHODS: Patients with histologically confirmed CD20 + low–tumor burden FL were randomly assigned to receive either rituximab, 375 mg/m 2 once daily on D1, D8, D15, and D22, intravenous route (IV, control arm), or rituximab, 375 mg/m 2 , on day 1 (D1), IV followed by rituximab 1,400 mg total dose, SC once daily on D8, D15, and D22, with maintenance at months 3 (M3), M5, M7, and M9 (experimental arm). The primary end point was PFS. Secondary end points included safety, overall response rates, TTNT, and overall survival (OS).RESULTS Two hundred two patients with low–tumor burden FL were randomly assigned to the experimental (n = 100) or control arm (n = 102). The primary end point was met: the 4-year PFS was 58.1% (95% CI, 47.5 to 67.4) and 41.2% (95% CI, 30.6 to 51.6) in experimental and control arms, respectively (hazard ratio, 0.585 [0.393 to 0.871]; P = .0076). Complete response (CR) rates were 59.0% (95% CI, 48.7 to 68.7) in the experimental arm and 36.3% (95% CI, 27.0 to 46.4) in the control arm ( P = .001). TTNT and OS were not significantly different. CR was associated with longer PFS and TTNT. High rituximab exposure during the first three months was independently associated with higher CR, PFS, and TTNT.CONCLUSION SC rituximab improves PFS for patients with low–tumor burden FL when used in induction followed by short maintenance. High rituximab exposure during the first 3 months after treatment initiation is, however, the only parameter influencing patient outcomes.
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Dates et versions

hal-04212199 , version 1 (16-10-2023)

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Guillaume Cartron, Emmanuel Bachy, Hervé Tilly, Nicolas Daguindau, Gian-Matteo Pica, et al.. Randomized Phase III Trial Evaluating Subcutaneous Rituximab for the First-Line Treatment of Low–Tumor Burden Follicular Lymphoma: Results of a LYSA Study. Journal of Clinical Oncology, 2023, 41 (19), pp.3523-3533. ⟨10.1200/JCO.22.02327⟩. ⟨hal-04212199⟩
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