{"entity":{"id":"paper-remarc-lenalidomide-maintenance-dlbcl-jco-2017","kind":"paper","name":"Lenalidomide maintenance compared with placebo in responding elderly patients with diffuse large B-cell lymphoma treated with first-line R-CHOP","aka":["REMARC","Thieblemont 2017"],"tldr":"Two years of a tablet after chemotherapy delayed relapse in older people with aggressive lymphoma but did not help them live longer.","summary":"A randomised phase 3 trial in 650 patients aged 60 to 80 with previously untreated diffuse large B-cell lymphoma or another aggressive B-cell lymphoma who had reached a complete or partial response after six or eight cycles of R-CHOP. They received lenalidomide 25 mg daily for 21 days of each 28-day cycle for 24 months, or placebo.\n\nAt the primary analysis in December 2015, with a median follow-up of 39 months from randomisation, median progression-free survival was not reached with lenalidomide against 58.9 months with placebo (hazard ratio 0.708, 95 per cent confidence interval 0.537 to 0.933, p = 0.01). The result was consistent across subgroups by sex, age-adjusted International Prognostic Index, age, response quality after R-CHOP and positron emission tomography status at randomisation. With longer follow-up to October 2016 (median 52 months), overall survival was similar between the arms (hazard ratio 1.218, 0.861 to 1.721, p = 0.26). Grade 3 or 4 neutropenia occurred in 56 against 22 per cent and cutaneous reactions in 5 against 1 per cent.","asOf":"2026-10-01","links":[{"label":"Journal of Clinical Oncology 2017","url":"https://doi.org/10.1200/JCO.2017.72.6984"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/28426350/"},{"label":"Europe PMC","url":"https://europepmc.org/article/MED/28426350"}],"tags":["lymphoma-evidence"],"related":["lymphoma-roadmap"],"cancers":["dlbcl","non-hodgkin-lymphoma"],"sections":["immunotherapy"],"technologies":[],"targets":[],"drugs":["lenalidomide","rituximab"],"companies":["lysa"],"institutions":[],"pathways":[],"terms":["maintenance-therapy","lymphoma-tx-maintenance","r-chop"],"trials":["remarc"],"people":["catherine-thieblemont","gilles-salles"],"bottlenecks":["b-toxicity-qol","b-aging-comorbidity"],"keyPapers":[],"journals":["jco"],"dependsOn":[],"notes":[],"journal":"Journal of Clinical Oncology","year":2017,"doi":"10.1200/JCO.2017.72.6984","pmid":"28426350","authors":"Thieblemont C, Tilly H, Gomes da Silva M, et al.","paperType":"rct","findings":["Median progression-free survival was not reached with lenalidomide maintenance against 58.9 months with placebo (hazard ratio 0.708, 95 per cent confidence interval 0.537 to 0.933, p = 0.01).","The effect was consistent across the analysed subgroups, including positron emission tomography status at randomisation.","Overall survival was similar between arms at a median follow-up of 52 months (hazard ratio 1.218, 0.861 to 1.721, p = 0.26).","Grade 3 or 4 neutropenia occurred in 56 per cent on lenalidomide against 22 per cent on placebo."],"whatItMeans":"A clean example of a progression-free survival benefit that did not become a survival benefit. Lenalidomide maintenance did not become standard practice after this trial, and the figures are the reason.","caveats":["Progression-free survival and overall survival were reported at different data cut-offs, 39 and 52 months.","Restricted to patients aged 60 to 80 who had already responded to R-CHOP.","Two years of daily tablets with grade 3 or 4 neutropenia in over half the treated group is a substantial burden for a benefit confined to one endpoint."],"changedPractice":false,"participants":650},"route":"/key-papers/paper-remarc-lenalidomide-maintenance-dlbcl-jco-2017/","neighbours":{"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":"immunotherapy","kind":"section","name":"Immunotherapy","route":"/fronts/immunotherapy/"}],"drug":[{"id":"lenalidomide","kind":"drug","name":"Lenalidomide","route":"/drugs/lenalidomide/"},{"id":"rituximab","kind":"drug","name":"Rituximab","route":"/drugs/rituximab/"}],"company":[{"id":"lysa","kind":"company","name":"LYSA (The Lymphoma Study Association)","route":"/companies/lysa/"}],"term":[{"id":"lymphoma-tx-maintenance","kind":"term","name":"Maintenance and consolidation in lymphoma: where it works and where it does not","route":"/terms/lymphoma-tx-maintenance/"},{"id":"maintenance-therapy","kind":"term","name":"Maintenance therapy","route":"/terms/maintenance-therapy/"},{"id":"r-chop","kind":"term","name":"R-CHOP (lymphoma chemoimmunotherapy)","route":"/terms/r-chop/"}],"trial":[{"id":"remarc","kind":"trial","name":"REMARC","route":"/trials/remarc/"}],"person":[{"id":"catherine-thieblemont","kind":"person","name":"Catherine Thieblemont","route":"/people/catherine-thieblemont/"},{"id":"gilles-salles","kind":"person","name":"Gilles Salles","route":"/people/gilles-salles/"}],"bottleneck":[{"id":"b-aging-comorbidity","kind":"bottleneck","name":"Older and multimorbid patients are excluded and undertreated","route":"/bottlenecks/b-aging-comorbidity/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}],"journal":[{"id":"jco","kind":"journal","name":"Journal of Clinical Oncology","route":"/journals/jco/"}]}}