{"entity":{"id":"remarc","kind":"trial","name":"REMARC","aka":["Lenalidomide maintenance in elderly diffuse large B-cell lymphoma","REMARC trial"],"tldr":"Two years of a tablet taken after chemotherapy delayed relapse in older people with aggressive lymphoma but did not help them live longer, and caused low white cell counts in over half.","summary":"REMARC randomised 650 people aged 60 to 80 who had reached a complete or partial response after first-line R-CHOP to lenalidomide 25 mg daily for 21 of every 28 days for 24 months, or placebo.\n\nAt the primary analysis, 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, a hazard ratio of 0.708 (95 per cent confidence interval 0.537 to 0.933, p = 0.01). The effect was consistent by sex, by age-adjusted International Prognostic Index, by response quality and by positron emission tomography status at randomisation. With longer follow-up of 52 months, overall survival was no different (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, and cutaneous reactions in 5 against 1 per cent.\n\nREMARC is the clearest example in aggressive lymphoma of a maintenance strategy that delays progression without extending life, and of why that distinction is worth explaining to a patient weighing two years of tablets and blood counts. Lenalidomide maintenance did not become a standard of care on this result.","status":"mixed","asOf":"2026-10-01","links":[{"label":"ClinicalTrials.gov NCT01122472","url":"https://clinicaltrials.gov/study/NCT01122472"},{"label":"Journal of Clinical Oncology 2017","url":"https://doi.org/10.1200/JCO.2017.72.6984"}],"tags":["lymphoma-evidence"],"related":[],"cancers":["dlbcl","non-hodgkin-lymphoma"],"sections":["immunotherapy","chemotherapy"],"technologies":[],"targets":[],"drugs":["lenalidomide","rituximab"],"companies":["lysa"],"institutions":[],"pathways":[],"terms":["maintenance-therapy","lymphoma-tx-maintenance","r-chop","ipi-score"],"trials":[],"people":["catherine-thieblemont","gilles-salles"],"bottlenecks":["b-toxicity-qol","b-aging-comorbidity"],"keyPapers":["paper-remarc-lenalidomide-maintenance-dlbcl-jco-2017"],"journals":[],"dependsOn":[],"notes":[],"nct":"NCT01122472","phase":"3","setting":"Aged 60 to 80, in complete or partial response after six or eight cycles of R-CHOP: two years of lenalidomide maintenance against placebo","sponsor":"The Lymphoma Academic Research Organisation","result":"Progression-free survival hazard ratio 0.708 (p = 0.01); overall survival unchanged (hazard ratio 1.218, p = 0.26), with grade 3 or 4 neutropenia in 56 per cent.","started":"2009-04","yearReported":2017,"enrolled":650,"enrolledBasis":"registry","outcomes":[{"endpoint":"Progression-free survival","primary":true,"unit":"months","arms":[{"name":"Lenalidomide maintenance","note":"median not reached"},{"name":"Placebo","value":58.9}],"hr":0.708,"ci":[0.537,0.933],"p":"0.01","source":"https://doi.org/10.1200/JCO.2017.72.6984"},{"endpoint":"Overall survival","arms":[{"name":"Lenalidomide maintenance"},{"name":"Placebo"}],"hr":1.218,"ci":[0.861,1.721],"p":"0.26"}],"replication":"Not replicated; the contemporaneous first-line lenalidomide combinations took a different route."},"route":"/trials/remarc/","neighbours":{"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/"},{"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":"ipi-score","kind":"term","name":"International Prognostic Index (IPI)","route":"/terms/ipi-score/"},{"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/"}],"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/"}],"paper":[{"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","route":"/key-papers/paper-remarc-lenalidomide-maintenance-dlbcl-jco-2017/"}],"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/"}]}}