Fifty years ago, a curative combination chemotherapy to diffuse large B-cell lymphoma (DLBCL) called CHOP quickly became first-line therapy for this common disease. Twenty-five years ago, the immunotherapy rituximab (an antibody directed to a B-cell surface marker called CD20) was added to CHOP to form RCHOP. This was a huge advance for first-line therapy, but it added some additional toxicity and additional cost. Recently, oncologists were hoping that the POLARIX trial would really cool down some hot lymphomas!
The POLARIX trial tests Pola-RCHP against the best first-line therapy and standard of care in the U.S., RCHOP. One of the oldest and cheapest chemotherapy drugs, vincristine, was taken out, and polatuzumab vedotin, an antibody-drug conjugate (ADC) directed against another marker, CD79b, was added. The data leading to the recent first-line FDA approval was based on efficacy, fewer patients needing to move to second-line therapy). Side effects are considerable, but not worse than RCHOP. ADCs are slowly replacing old chemotherapy drugs, but the “financial toxicity,” cost of therapy, is considerable. Oncologists like to cure more patients in the first-line setting, and the new program is helping this to happen.
Fred Hardwicke practices medical oncology at Childress Regional Medical Center (CRMC), 901 U.S. Hwy 83. To contact CRMC, call 940-937-6371.
