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Dr Francesc Graus from the Neurology Service Hospital Clinic, Barcelona, Spain, presented a session based on results from a range of multidisciplinary studies focused on identifying optimal treatment regimens for patients with Primary Central Nervous System Lymphoma (PCNSL) at the ESMO congress 2016, at Copenhagen, Denmark.
Dr Graus discussed, through the presentation of the case studied, the main questions raised for the treatment of a primary CNS lymphoma.
The role of chemoimmunotherapy was confirmed by the IELSG phase 2 trial published recently by Ferreri et al. in the Lancet Hematology. 219 PCNSL patients were given either MTX/cytarabine alone or in combination with rituximab, or rituximab and thiotepa. The primary outcome of this trial was to compare the complete response of participants to the different treatment regimes. The trial results showed that patients treated with rituximab plus thiotepa had a CRR of 49% compared with 23% for MTX/cytarabine alone and 30% for MTX/cytarabine/rituximab.
Finally, the question of treatment options for PCNSL relapses was raised. One study with a primary outcome to investigate MTX re-challenge to 39 PCNSL patients who responded previously to MTX therapy and experienced relapse was presented. The trial data revealed that the 1-year OS was 79% and the median OS was 41 months, thus suggesting MTX re-challenge is effective in relapsed PCNSL patients.
On-going clinical trials are underway for patients with either relapsed or progressive PCNSL using different therapeutic agents and the results in terms of OS are promising.
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