Mark J. Roschewski, MD, staff clinician, associate research clinician, clinical director, Malignancies Branch of the Center for Cancer Research, National Cancer Institute, discusses the use of dose-adjusted infused etoposide, doxorubicin, and cyclophosphamide with vincristine, prednisone, and rituximab (Rituxan; DA-EPOCH-R) in patients with Burkitt lymphoma.

A recent study by the NCI investigated DA-EPOCH-R in patients with Burkitt lymphoma. The primary endpoint was event-free survival (EFS), with secondary endpoints of progression-free survival, time to progression, overall survival and predictive ability of PET after 2 cycles. Results showed that this regimen is active and efficacious in adults of all ages with Burkitt lymphoma, with a favorable 3-year EFS compared to intensive regimens.

Roschewski says that DA-EPOCH-R is extremely effective in Burkitt lymphoma. Moving from a more intensive regimen to a less-intensive regimen can make some clinicians anxious, but Roschewski believes that the data support this approach. DA-EPOCH-R should be the standard approach for adult patients with Burkitt lymphoma, Roschewski concludes.

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Mark J. Roschewski, MD, staff clinician, associate research clinician, clinical director, Malignancies Branch of the Center for Cancer Research, National Cancer Institute, discusses the use of dose-adjusted infused etoposide, doxorubicin, and cyclophosphamide with vincristine, prednisone, and rituximab (Rituxan; DA-EPOCH-R) in patients with Burkitt lymphoma.
 

Dr. Roschewski on the Use of DA-EPOCH-R in Burkitt Lymphoma

Mark J. Roschewski, MD, staff clinician, associate research clinician, clinical director, Malignancies Branch of the Center for Cancer Research, National Cancer Institute, discusses the treatment of Burkitt lymphoma in adult patients.

There is a difference in the way that patients with Burkitt lymphoma are treated based on their age, says Roschewski. This is a lymphoma that occurs more frequently in pediatric patients, many of whom can often be cured with intensive chemotherapy. The cure rate is as high as 95%, but the outcomes for adults are not as good, Roschewski says. This is due in part to the toxicities associated with intensive chemotherapy.

It is common that adults with Burkitt lymphoma either discontinue treatment with chemotherapy, or die of the toxicities—making the need for therapy very high. This problem came about because the treatments for all Burkitt lymphoma were derived from pediatrics, says Roschewski. Children metabolize chemotherapy much more efficiently than adults and are less likely to have comorbidities, allowing for dose-intensity and high cure rates.

Mark J. Roschewski, MD, staff clinician, associate research clinician, clinical director, Malignancies Branch of the Center for Cancer Research, National Cancer Institute, discusses the treatment of Burkitt lymphoma in adult patients.
 

Dr. Roschewski on the Treatment of Burkitt Lymphoma in Adults

Mark J. Roschewski, MD, staff clinician, associate research clinician, clinical director, Malignancies Branch of the Center for Cancer Research, National Cancer Institute, discusses dose-adjusted infused etoposide, doxorubicin, and cyclophosphamide with vincristine, prednisone, and rituximab (Rituxan; DA-EPOCH-R) in adult patients with Burkitt lymphoma.

Burkitt lymphoma is rarely found in adults, and treatment-related toxicities are a significant barrier to treatment. The current standard of care for these patients is an intensive regimen of chemotherapy.

An NCI study investigated DA-EPOCH-R in patients with Burkitt lymphoma. The primary endpoint was event-free survival (EFS), with secondary objections of progression-free survival, time to progression, overall survival and predictive ability of PET after 2 cycles. All stages of Burkitt lymphoma were allowed, regardless of HIV status, says Roschewski.

Results showed that DA-EPOCH-R is effective in adults of all ages, with a favorable 3-year EFS compared to intensive regimens, and a low rate of central nervous system failure. Additionally, Roschewski notes that all 14 patients with low-risk Burkitt lymphoma on this study were cured.

Mark J. Roschewski, MD, staff clinician, associate research clinician, clinical director, Malignancies Branch of the Center for Cancer Research, National Cancer Institute, discusses dose-adjusted infused etoposide, doxorubicin, and cyclophosphamide with vincristine, prednisone, and rituximab (Rituxan; DA-EPOCH-R) in adult patients with Burkitt lymphoma.
 

Mark J. Roschewski, MD

Articles

Dr. Roschewski on the Use of DA-EPOCH-R in Burkitt Lymphoma

Dr. Roschewski on the Treatment of Burkitt Lymphoma in Adults

Dr. Roschewski Discusses DA-EPOCH-R in Burkitt Lymphoma