{"entity":{"id":"paper-calgb-50303-da-epoch-r-vs-r-chop-jco-2019","kind":"paper","name":"Dose-adjusted EPOCH-R compared with R-CHOP as frontline therapy for diffuse large B-cell lymphoma: clinical outcomes of the phase III intergroup trial Alliance/CALGB 50303","aka":["CALGB 50303","Bartlett 2019"],"tldr":"An intensive infusional chemotherapy regimen that many centres had adopted on single-arm evidence was no better than the standard when finally compared head to head, and was harder to tolerate.","summary":"An intergroup phase 3 trial comparing six cycles of dose-adjusted EPOCH-R with six cycles of R-CHOP as frontline therapy for diffuse large B-cell lymphoma. 524 patients were registered between 2005 and 2013 and 491 were eligible for the final analysis; 74 per cent had stage III or IV disease.\n\nAt a median follow-up of five years, progression-free survival did not differ (hazard ratio 0.93, 95 per cent confidence interval 0.68 to 1.27, p = 0.65) with two-year rates of 78.9 and 75.5 per cent, and neither did overall survival (hazard ratio 1.09, 0.75 to 1.59, p = 0.64) with two-year rates of 86.5 and 85.7 per cent. Grade 3 and 4 adverse events were more common with dose-adjusted EPOCH-R, including febrile neutropenia in 35.0 against 17.7 per cent, mucositis in 8.4 against 2.1 per cent and neuropathy in 18.6 against 3.3 per cent. Five treatment-related deaths occurred in each arm.","asOf":"2026-10-01","links":[{"label":"Journal of Clinical Oncology 2019","url":"https://doi.org/10.1200/JCO.18.01994"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/30939090/"},{"label":"Europe PMC","url":"https://europepmc.org/article/MED/30939090"}],"tags":["lymphoma-evidence"],"related":["paper-dunleavy-da-epoch-r-pmbcl-nejm-2013","lymphoma-roadmap"],"cancers":["dlbcl","non-hodgkin-lymphoma"],"sections":["chemotherapy"],"technologies":[],"targets":[],"drugs":["rituximab","etoposide","cyclophosphamide","doxorubicin","vincristine","prednisone"],"companies":[],"institutions":["nci"],"pathways":[],"terms":["r-chop","lymphoma-tx-regimen-alphabet","double-hit-lymphoma"],"trials":["calgb-50303"],"people":[],"bottlenecks":["b-negative-results","b-trial-design"],"keyPapers":[],"journals":["jco"],"dependsOn":[],"notes":[],"journal":"Journal of Clinical Oncology","year":2019,"doi":"10.1200/JCO.18.01994","pmid":"30939090","authors":"Bartlett NL, Wilson WH, Jung SH, et al.","paperType":"rct","findings":["Progression-free survival did not differ between dose-adjusted EPOCH-R and R-CHOP (hazard ratio 0.93, 95 per cent confidence interval 0.68 to 1.27, p = 0.65).","Two-year progression-free survival was 78.9 per cent for dose-adjusted EPOCH-R and 75.5 per cent for R-CHOP.","Overall survival did not differ (hazard ratio 1.09, 0.75 to 1.59, p = 0.64).","Febrile neutropenia occurred in 35.0 against 17.7 per cent, mucositis in 8.4 against 2.1 per cent and neuropathy in 18.6 against 3.3 per cent.","Five treatment-related deaths (2.1 per cent) occurred in each arm."],"whatItMeans":"R-CHOP remains the standard first-line regimen for diffuse large B-cell lymphoma. The trial is also the clearest lesson in the disease about adopting a regimen on single-arm data: dose-adjusted EPOCH-R had been used widely for a decade before this comparison existed.","caveats":["The authors note that R-CHOP results were better than historical controls, which suggests patient selection and limits generalisability to specific high-risk subgroups.","Not powered for subgroups such as double-hit lymphoma, where dose-adjusted EPOCH-R is still used on non-randomised evidence.","Primary mediastinal B-cell lymphoma and HIV-associated lymphoma, where dose-adjusted EPOCH-R has its strongest evidence, were studied separately."],"changedPractice":true,"participants":491},"route":"/key-papers/paper-calgb-50303-da-epoch-r-vs-r-chop-jco-2019/","neighbours":{"paper":[{"id":"paper-dunleavy-da-epoch-r-pmbcl-nejm-2013","kind":"paper","name":"Dose-adjusted EPOCH-rituximab therapy in primary mediastinal B-cell lymphoma","route":"/key-papers/paper-dunleavy-da-epoch-r-pmbcl-nejm-2013/"}],"roadmap":[{"id":"lymphoma-roadmap","kind":"roadmap","name":"Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting","route":"/roadmaps/lymphoma-roadmap/"}],"cancer":[{"id":"dlbcl","kind":"cancer","name":"Diffuse large B-cell lymphoma","route":"/cancers/dlbcl/"},{"id":"non-hodgkin-lymphoma","kind":"cancer","name":"Non-Hodgkin lymphoma (all types)","route":"/cancers/non-hodgkin-lymphoma/"}],"section":[{"id":"chemotherapy","kind":"section","name":"Chemotherapy","route":"/fronts/chemotherapy/"}],"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":"double-hit-lymphoma","kind":"term","name":"Double-hit / high-grade B-cell lymphoma","route":"/terms/double-hit-lymphoma/"},{"id":"r-chop","kind":"term","name":"R-CHOP (lymphoma chemoimmunotherapy)","route":"/terms/r-chop/"},{"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/"}],"bottleneck":[{"id":"b-negative-results","kind":"bottleneck","name":"Failures are hidden","route":"/bottlenecks/b-negative-results/"},{"id":"b-trial-design","kind":"bottleneck","name":"Trial design, endpoints and cost","route":"/bottlenecks/b-trial-design/"}],"journal":[{"id":"jco","kind":"journal","name":"Journal of Clinical Oncology","route":"/journals/jco/"}]}}