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Hess G, Hüttmann A, Witzens-Harig M, Dreyling MH, Keller U, Marks R, Ernst T, Pott C, Viardot A, Frontzek F, Trautmann M, Ruckes C, Deuster O, Rosenwald A, Theobald M, Lenz G. A phase II trial to evaluate the combination of pixantrone and obinutuzumab for patients with relapsed aggressive lymphoma: Final results of the prospective, multicentre GOAL trial. Br J Haematol 2022; 198:482-491. [PMID: 35362552 DOI: 10.1111/bjh.18161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/08/2022] [Accepted: 03/13/2022] [Indexed: 12/14/2022]
Abstract
The prognosis of patients with relapsed diffuse large B-cell lymphoma (DLBCL) remains poor with current options. Here we prospectively evaluated the combination of pixantrone with obinutuzumab for up to six cycles for patients with relapsed or refractory DLBCL. Overall response rate (ORR) was the primary end-point. Sixty-eight patients were evaluated, median age was 75 years, median number of prior lines was three (range 1-10), 52 patients (76.5%) were diagnosed with DLBCL and 16 (23.5%) patients had transformed indolent lymphoma or follicular lymphoma (FL) IIIB. ORR was 35.3% for all and 40% for evaluable patients (16.6% complete response), median progression-free survival (PFS) and overall survival (OS) were 2.8 months and 8 months, respectively. Analysis of the cell of origin revealed a superior course for patients with non-GCB (germinal centre B-cell-like) phenotype [median OS not reached (n.r.) vs 5.2 months]. Patients with one prior line had an improved outcome over patients treated in later lines (PFS n.r. vs 2.5 months). Disease progression was the main reason for premature termination. Adverse events were mainly haematologic. The combination treatment revealed no unexpected adverse events. Most relevant non-haematologic toxicity was infection in 28% of patients. In summary, pixantrone-obinutuzumab showed clinical activity with sometimes long-term remission; however, the trial failed to meet its primary end-point.
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Affiliation(s)
- Georg Hess
- Department of Internal Medicine III, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Andreas Hüttmann
- Department of Hematology, University Hospital Essen, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | - Mathias Witzens-Harig
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin H Dreyling
- Department of Internal Medicine III, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Ulrich Keller
- Internal Medicine III, Technical University of Munich, Munich, Germany
| | - Reinhard Marks
- Department of Hematology/Oncology and Stem Cell Transplantation, University Medical Center, Freiburg, Germany
| | - Thomas Ernst
- Department of Internal Medicine II, Jena University Hospital, Jena, Germany
| | - Christiane Pott
- Department of Internal Medicine II, University of Schleswig-Holstein, Kiel, Germany
| | - Andreas Viardot
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - Fabian Frontzek
- Department of Medicine A, University Hospital Münster, Münster, Germany
| | - Marcel Trautmann
- Division of Translational Pathology, Gerhard Domagk Institute of Pathology, Münster University Hospital, Münster, Germany
| | - Christian Ruckes
- Interdisciplinary Center for Clinical Trials (IZKS), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Oliver Deuster
- Interdisciplinary Center for Clinical Trials (IZKS), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | | | - Matthias Theobald
- Department of Internal Medicine III, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Georg Lenz
- Department of Medicine A, University Hospital Münster, Münster, Germany
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Jezeršek Novaković B, Boltežar L, Novaković A. Current Opinion on Pixantrone in the Treatment of Non-Hodgkin B-Cell Lymphoma. Ther Clin Risk Manag 2021; 17:183-192. [PMID: 33688197 PMCID: PMC7936695 DOI: 10.2147/tcrm.s269324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/16/2021] [Indexed: 11/26/2022] Open
Abstract
Not many treatment options exist for patients with relapsed or refractory (R/R) B-cell non-Hodgkin lymphoma (NHL) in whom first- and second-line therapies were unsuccessful. This is especially true for patients with aggressive lymphomas. The innovative agent pixantrone has shown some promising results in terms of disease-free and overall survival, both in monotherapy as well as in combinations. However, recent trials (Phase III and real-world studies) reported unsatisfactory results, thereby raising the question about the role of pixantrone in the current treatment of R/R aggressive lymphomas. Nonetheless, there might still be a potential position for this drug in combinations, for use as first-line treatment of patients with cardiac dysfunction. This article summarizes the definition, structure, mechanism of action and reduced cardiotoxicity of pixantrone as well as efficacy and toxicity both in monotherapy and in combinations, as treatment for aggressive and indolent non-Hodgkin lymphomas.
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Affiliation(s)
| | - Lučka Boltežar
- Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, 1000, Slovenia
| | - Aleksander Novaković
- Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, 1000, Slovenia
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