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ATLANTA – Once the most common treatment for indolent non-Hodgkin's Lymphoma, the combination chemotherapy known as CHOP is rapidly falling to the wayside in Germany – replaced by bendamustine (Treanda), frequently combined with rituximab (Rituxan), researchers reported here.

In a German study, CHOP – cyclophosphamide, doxorubicin, vincristine and prednisone, sometimes combined with rituxan (R-CHOP) – accounted for just 16% of treatment for patients with indolent lymphoma, while bendamustine was part of first-line therapy in 71% of patients, according to Wolfgang Knauf, MD, professor of hematology at Onkologische Gemeinschaftspraxix, Frankfurt/Main.

"R-CHOP is dead," he told 番茄社区app at his poster presentation during the annual meeting of the American Society of Hematology. "The registry data we are showing is a description of what is going on in Germany."

The registry is recruiting 1,000 patients with indolent lymphomas, 1,000 with chronic myelogenous leukemia, 500 with myeloma, and 1,000 patients with aggressive lymphomas. Knauf and colleagues presented data on treatment for 645 patients.

Knauf said that rituximab is used in 94% of treatment. It is combined with bendamustine in 66% of the cases. Bendamustine-rituximab was employed 428 times. Another 2% of doctors used bendamustine as a monotherapy.

As a second-line therapy, bendamustine again is used more often than CHOP, Knauf illustrated. Of those 121 cases, rituximab was administered to 102 patients; bendamustine was used in 82 patients – in combination with rituximab in 72 patients. R-CHOP was used as a second-line treatment in nine patients.

Knauf said the researchers in Germany expect to be able to present outcome data from the registry next year, but he cited recent clinical trials that showed an advantage for patients treated with bendamustine-based regimens when compared with CHOP-based treatment schedules.

"Our message as of now is that rituximab-CHOP can no longer be considered as a standard-of-care," Knauf said.

"CHOP is going to be dead," agreed Frederick Lansigan, MD, assistant professor of medicine at Dartmouth-Hitchcock Medical Center, Lebanon, N.H. He told 番茄社区app that trial results with bendamustine showing longer progression-free survival "are very compelling."

Lansigan presented his preliminary findings combining rituximab-bendamustine with 90 ibritumomab tiuxetan - a monoclonal antibody chemotherapy for non-Hodgkin's lymphoma. In that trial, bendamustine-rituximab was followed with the radioimmunotherapy agent in an attempt to consolidate the gains in response.

He said his treatment decreased the length of time on bendamustine from six cycles to four cycles in an attempt to reduce toxicities. His report, however, just included 13 patients. The promising results, he said, warrant enrolling up to 39 patients to determine if the effect seen is more than transitory.

Although the role of CHOP therapy is diminished, its obituary might be premature, said Andre Goy, MD, chief of the lymphoma division at Hackensack University Medical Center in New Jersey.

"There is no question that the progression-free survival is dramatically different with bendamustine," Goy told 番茄社区app. "We have to be careful the way we look at these data. There was no difference in complete response rate and in overall survival. Progression-free survival in follicular lymphoma does not necessarily translate into overall survival. And there are some hints that bendamustine may be a bit more toxic than its perception."

Goy said that bendamustine appear to be a "great" alternative to CHOP, but it may not be the end of CHOP because there could be subsets of patients though would benefit from the more aggressive treatment that CHOP offers.