{"entity":{"id":"nci-da-epoch-r-myc-burkitt","kind":"trial","name":"NCI dose-adjusted EPOCH-R in Burkitt and MYC-rearranged large B-cell lymphoma","aka":["DA-EPOCH-R in MYC-rearranged lymphoma","Dunleavy 2018"],"tldr":"A single-arm study gave an intensive infusional chemotherapy to people with aggressive B-cell lymphoma carrying a MYC rearrangement, including double-hit disease, and about seven in ten were alive and free of events four years later.","summary":"Retrospective series had suggested that aggressive B-cell lymphomas with a MYC rearrangement, alone or with a BCL2 or BCL6 rearrangement, do worse with R-CHOP than without one. This NCI-sponsored phase 2 study gave dose-adjusted EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab), with CNS prophylaxis, for six cycles. The registry lists Burkitt lymphoma, MYC-positive diffuse large B-cell lymphoma and plasmablastic lymphoma among its conditions and 194 participants in total.\n\nThe final analysis of the MYC-rearranged large B-cell cohort (Lancet Haematology 2018) covers 53 patients, median age 61, 81 per cent with stage III or IV disease; 19 had a MYC rearrangement alone and 24 also had a BCL2 or BCL6 rearrangement, or both. After a median follow-up of 55.6 months, 48-month event-free survival was 71.0 per cent and overall survival 76.7 per cent. Grade 4 neutropenia occurred in 53 per cent of cycles and there were three treatment-related deaths, all from infection. The authors concluded the regimen should be considered for these diseases.\n\nIt is single-arm. The randomised CALGB 50303 found no advantage for the same regimen over R-CHOP in unselected diffuse large B-cell lymphoma, and no randomised trial has been confined to MYC-rearranged or double-hit disease.","status":"positive","asOf":"2026-11-03","links":[{"label":"ClinicalTrials.gov NCT01092182","url":"https://clinicaltrials.gov/study/NCT01092182"},{"label":"Lancet Haematology 2018","url":"https://doi.org/10.1016/S2352-3026(18)30177-7"}],"tags":["lymphoma-evidence-entities"],"related":[],"cancers":["high-grade-b-cell-lymphoma-myc-bcl2","dlbcl","burkitt-lymphoma","plasmablastic-lymphoma","non-hodgkin-lymphoma"],"sections":["chemotherapy"],"technologies":["cytotoxic-chemotherapy"],"targets":["myc-gene","bcl2"],"drugs":["rituximab","etoposide","prednisone","vincristine","cyclophosphamide","doxorubicin"],"companies":[],"institutions":["nci"],"pathways":[],"terms":["double-hit-lymphoma","lymphoma-tx-cns-prophylaxis","lymphoma-tx-regimen-alphabet"],"trials":["calgb-50303"],"people":[],"bottlenecks":[],"keyPapers":["paper-da-epoch-r-myc-rearranged-lymphoma-lancet-haematol-2018"],"journals":[],"dependsOn":[],"notes":[],"nct":"NCT01092182","phase":"2","setting":"Untreated Burkitt lymphoma, MYC-rearranged diffuse large B-cell lymphoma and plasmablastic lymphoma: dose-adjusted EPOCH-R with CNS prophylaxis","sponsor":"National Cancer Institute (NCI)","result":"In 53 patients with MYC-rearranged aggressive B-cell lymphoma, 48-month event-free survival 71.0 per cent and overall survival 76.7 per cent.","started":"2010-03-25","startedType":"actual","yearReported":2018,"enrolled":194,"enrolledBasis":"registry","outcomes":[{"endpoint":"Event-free survival at 48 months","primary":true,"unit":"%","arms":[{"name":"DA-EPOCH-R, MYC-rearranged cohort","n":53,"value":71,"note":"95 per cent confidence interval 56.5 to 81.4"}],"source":"https://doi.org/10.1016/S2352-3026(18)30177-7"},{"endpoint":"Overall survival at 48 months","primary":true,"unit":"%","arms":[{"name":"DA-EPOCH-R, MYC-rearranged cohort","n":53,"value":76.7,"note":"95 per cent confidence interval 62.6 to 86.1"}],"source":"https://doi.org/10.1016/S2352-3026(18)30177-7"}],"replication":"Single arm. The randomised CALGB 50303 found no benefit for the same regimen in unselected diffuse large B-cell lymphoma."},"route":"/trials/nci-da-epoch-r-myc-burkitt/","neighbours":{"cancer":[{"id":"burkitt-lymphoma","kind":"cancer","name":"Burkitt lymphoma","route":"/cancers/burkitt-lymphoma/"},{"id":"dlbcl","kind":"cancer","name":"Diffuse large B-cell lymphoma","route":"/cancers/dlbcl/"},{"id":"high-grade-b-cell-lymphoma-myc-bcl2","kind":"cancer","name":"High-grade B-cell lymphoma with MYC and BCL2 rearrangements (double-hit lymphoma)","route":"/cancers/high-grade-b-cell-lymphoma-myc-bcl2/"},{"id":"non-hodgkin-lymphoma","kind":"cancer","name":"Non-Hodgkin lymphoma (all types)","route":"/cancers/non-hodgkin-lymphoma/"},{"id":"plasmablastic-lymphoma","kind":"cancer","name":"Plasmablastic lymphoma","route":"/cancers/plasmablastic-lymphoma/"}],"section":[{"id":"chemotherapy","kind":"section","name":"Chemotherapy","route":"/fronts/chemotherapy/"}],"technology":[{"id":"cytotoxic-chemotherapy","kind":"technology","name":"Cytotoxic chemotherapy","route":"/technologies/cytotoxic-chemotherapy/"}],"target":[{"id":"bcl2","kind":"target","name":"BCL-2","route":"/targets/bcl2/"},{"id":"myc-gene","kind":"target","name":"MYC","route":"/targets/myc-gene/"}],"drug":[{"id":"cyclophosphamide","kind":"drug","name":"Cyclophosphamide","route":"/drugs/cyclophosphamide/"},{"id":"doxorubicin","kind":"drug","name":"Doxorubicin","route":"/drugs/doxorubicin/"},{"id":"etoposide","kind":"drug","name":"Etoposide","route":"/drugs/etoposide/"},{"id":"prednisone","kind":"drug","name":"Prednisone","route":"/drugs/prednisone/"},{"id":"rituximab","kind":"drug","name":"Rituximab","route":"/drugs/rituximab/"},{"id":"vincristine","kind":"drug","name":"Vincristine","route":"/drugs/vincristine/"}],"institution":[{"id":"nci","kind":"institution","name":"National Cancer Institute (NIH)","route":"/institutions/nci/"}],"term":[{"id":"lymphoma-tx-cns-prophylaxis","kind":"term","name":"CNS prophylaxis in aggressive B-cell lymphoma, and the evidence against it","route":"/terms/lymphoma-tx-cns-prophylaxis/"},{"id":"double-hit-lymphoma","kind":"term","name":"Double-hit / high-grade B-cell lymphoma","route":"/terms/double-hit-lymphoma/"},{"id":"lymphoma-tx-regimen-alphabet","kind":"term","name":"The lymphoma regimen alphabet: R-CHOP, pola-R-CHP, DA-EPOCH-R, ABVD, BEACOPP and the rest","route":"/terms/lymphoma-tx-regimen-alphabet/"}],"trial":[{"id":"calgb-50303","kind":"trial","name":"Alliance/CALGB 50303","route":"/trials/calgb-50303/"}],"paper":[{"id":"paper-da-epoch-r-myc-rearranged-lymphoma-lancet-haematol-2018","kind":"paper","name":"Dose-adjusted EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab) in untreated aggressive diffuse large B-cell lymphoma with MYC rearrangement: a prospective, multicentre, single-arm phase 2 study","route":"/key-papers/paper-da-epoch-r-myc-rearranged-lymphoma-lancet-haematol-2018/"}]}}