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Pilot study of an outpatient‐based approach for advanced lymphoma using vinorelbine, gemcitabine and filgrastim
Author(s) -
Spencer A,
Reed K,
Arthur C
Publication year - 2007
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/j.1445-5994.2007.01397.x
Subject(s) - medicine , vinorelbine , filgrastim , gemcitabine , febrile neutropenia , neutropenia , oncology , autologous stem cell transplantation , surgery , lymphoma , chemotherapy , cisplatin
Background: Vinorelbine and gemcitabine have demonstrable single‐agent activity against lymphoma, show differing toxicity profiles and can be given in an outpatient setting. Aims: We have evaluated the feasibility of an outpatient‐based combination of vinorelbine and gemcitabine with filgrastim support (VGF) in patients with advanced lymphoma. Methods: An open‐label, single‐arm study of 40 consecutive patients with relapsed ( n = 24) or refractory ( n = 16) lymphoma was undertaken. The median number of prior regimens was three (range 1–11) and 12 had undergone prior stem cell transplantation. Patients received vinorelbine 25 mg/m 2 and gemcitabine 1000 mg/m 2 on days 1 and 8 of each 21‐day cycle. Patients showing no response after two cycles (early response) were offered alternative therapy. Responding patients received two more cycles. Primary end‐points were the early and overall response rates. Results: One hundred and sixteen cycles of therapy were delivered. Hospital admissions were required following 27 treatment cycles (24%), predominantly following cycle 1. Febrile neutropenia followed 6% of cycles. The early and overall response rates on an intention‐to‐treat basis were 60 and 53%, respectively. Responses for peripheral T‐cell lymphoma and Hodgkin lymphoma were particularly encouraging, 70 and 75%, respectively. With a median follow up of 34 months overall survival for the entire cohort at 2 years is 50%. Furthermore, for the 23 patients who did not receive high‐dose consolidative therapy 2‐year survival was 35%. Conclusions: Vinorelbine and gemcitabine with filgrastim support can be safely delivered in an outpatient setting and shows clinically meaningful activity against a range of advanced lymphoma subtypes.