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

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.

At 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.