ASCO 2018前瞻之五：DEVEC老而弥坚

橙色雨丝

DEVEC metronomic schedule for aggressive B and T-cell lymphomas.

Abstract:

Background: Metronomic chemotherapy (MC) is an emerging approach in solid tumours. Since MC has been poorly investigated in aggressive lymphomas in 2011, we formulated a new oral MC regimen termed DEVEC (Deltacortene, Etoposide, Navelbine, Cyclophosphamide).

Methods: The DEVEC foresees an induction and a deescalated maintenance phase both consisting in 6 cycles. Rituximab is administered in CD20+ cases. Patients with aggressive B and T cell lymphomas, unsuitable for standard-chemotherapies, were enrolled in 6 Italian institutions. HIV+ and CNS involvement were excluded. Data were retrieved as of 31th January 2018 (EC approval n° 4640).

Results: 58 patients started DEVEC between October 2011 and October 2017: the median follow-up time is 23 months. Median age was 79 years (26–93): 22 (37.9%) were refractory and 20 (34.5%) relapsed after previous treatments; 16 (27.62%) were treatment-naïve. Histology: DLBCL = 41(70.7%); PTCL = 15 (25.9%) and MCL = 2 (3.4%). By comprehensive geriatric assessment, patients scored as FIT = 7 (12%), UNFIT = 16 (27.6%), FRAIL = 23 (39.6%); Super-Frail (SF) = 10 (17.2%). In 53 evaluable cases the overall hematologic toxicity was mild and manageable with growth factors. Extra-hematologic toxicity of grade ≥3 was reported in 12/53 patients (22.6%) and were all classified as SAE: 6/12 cases occurred in SF. 5/12 patients discontinued DEVEC and died respectively 0, 1, 4, 4 and 5 months after treatment stop. In 50/53 patients, evaluable for outcome, the ORR was 68% and CR rate 44%. In the Naïve subset (n = 14) ORR = 92.8% and CR+CRu = 64%; in the Relapsed subset (n = 16): ORR = 93.7%; CR = 62.5%; in the Refractory subset (n = 20) ORR = 30%; CR = 10%. The estimated median OS and PFS were 15 (95%CI = 9.17-20.83) and 13 (CI 95% = 2.07-23.93) months, respectively. No significant differences in OS and PFS were observed in DLBCL vs PTCL. The direct cost of drugs of the oral DEVEC schedule was estimated 930 and 817 Euro (year 2016) for a single induction and maintenance cycle, respectively.

Conclusions: To our knowledge this is the largest series of aggressive lymphoma treated with MC. DEVEC induced sustained CR in a substantial proportion of patients with very poor outlook and deserves further studies in aggressive lymphomas.

橙色雨丝

对于身体状况差，无法耐受化疗的患者，口服节拍化疗不失为一种值得考虑的选择。意大利人为此做了一项研究，参与的患者既有T细胞，也有B细胞，都是侵袭性淋巴瘤，中位年龄79岁，其中大部分属于“不能化疗”，“虚弱”，“超级虚弱”的患者，其中初治、复发和耐药各占约三分之一。用泼尼松，依托泊苷，长春瑞滨和环磷酰胺组成的DEVEC口服节拍治疗后，总缓解率68%，CR率44%：其中CD20阳性的B细胞患者还用了美罗华。估算的中位OS和PFS分别是15和13个月，从风险获益比上来说物有所值。

hyjwjc

橙色雨丝 发表于 2018-5-20 18:48
对于身体状况差，无法耐受化疗的患者，口服节拍化疗不失为一种值得考虑的选择。意大利人为此做了一项研究， ...

刚刚看到您三年前发的文章也还留了言，您能看到吗？可以在那里帮我解答一下吗？谢谢

小猪泡泡

适合老年人，体弱的患者，不过国内这个方案不多

老婆我爱你

不好意思回复错了

一切都会好！

真的谢谢您！经常给我们学习新的知识。

繁里

谢谢你，又给一部分患者希望

鹰击

雨丝大大，你带给我的不仅是淋巴瘤的专业知识，还有暖暖的关爱，对你的信任度五颗星

hyjwjc

有原文链接吗？烦请橙大哥贴一个

活下去

希望这也能用于年轻人的纵膈淋巴肿瘤，那么多人就不需要放疗了。

降龙十八掌

多谢雨丝大神给大家带来前沿科学的知识！

ZXL217

这个方案推广的话也不错的呢

太多

雨丝大大，t淋母自体后9个月复发，骨髓侵犯80%，白细胞最高时140，现在西医已经没什么好办法，敢不敢去试试中医？谢谢雨丝大大

橙色雨丝

太多 发表于 2018-5-21 10:06
雨丝大大，t淋母自体后9个月复发，骨髓侵犯80%，白细胞最高时140，现在西医已经没什么好办法，敢不敢去试试 ...

别人敢不敢做某一件事情，我怎么可能知道。

太多

橙色雨丝 发表于 2018-5-21 10:20
别人敢不敢做某一件事情，我怎么可能知道。

雨丝大大，谢谢回复，我只是期望看有没有一线生机

fuzhubaizai

丝雨大大，能否给出具体用药方案呢？老头子弥漫大B现在已经无法化疗了，自体cart缓解两个月后复发，异体通用型cart无效。现在身体状况异体移植无法进行，今天开始用bcl-2抑制剂，教授建议接下来用伊布替尼缓解，然后再尝试自体cart，随后恢复一段时间异体移植。如果这几种方案无效，那么可能就要回到县医院姑息治疗，那么可能就要跟医生商量这种节拍治疗，所以请雨丝大大指点下这种节拍治疗的用药方案，感激不尽@橙色雨丝

橙色雨丝

fuzhubaizai 发表于 2018-6-23 01:08
丝雨大大，能否给出具体用药方案呢？老头子弥漫大B现在已经无法化疗了，自体cart缓解两个月后复发，异体通 ...

节拍化疗的方式有好几种，不过大同小异，这是其中一种：

fuzhubaizai

橙色雨丝 发表于 2018-6-23 09:21
节拍化疗的方式有好几种，不过大同小异，这是其中一种：

雨丝大神知道哪里可以做异体cart吗？现在病人没法做自体cart了，身体指标不够。谢谢

吴王氏

谢谢福音

橙色雨丝

fuzhubaizai 发表于 2018-6-26 12:07
雨丝大神知道哪里可以做异体cart吗？现在病人没法做自体cart了，身体指标不够。谢谢
...

不了解。