Quality-of-life-adjusted survival analysis of interferon alfa-2b treatment for advanced follicular lymphoma:: An aid to clinical decision making

被引:35
作者
Cole, BF
Solal-Céligny, P
Gelber, RD
Lepage, E
Gisselbrecht, C
Reyes, F
Sebban, C
Sugano, D
Tendler, C
Goldhirsch, A
机构
[1] Dartmouth Med Sch, Epidemiol & Biostat Sect, Lebanon, NH 03756 USA
[2] Grp Etude Lymphomes Folliculaires, Caen, France
[3] Grp Etude Lymphomes Folliculaires, Creteil, France
[4] Grp Etude Lymphomes Folliculaires, Lyon, France
[5] Grp Etude Lymphomes Folliculaires, Marseille, France
[6] Grp Etude Lymphomes Folliculaires, Nantes, France
[7] Grp Etude Lymphomes Folliculaires, Paris, France
[8] Grp Etude Lymphomes Folliculaires, Reims, France
[9] Grp Etude Lymphomes Folliculaires, Rouen, France
[10] Grp Etude Lymphomes Folliculaires, Toulouse, France
[11] Grp Etude Lymphomes Folliculaires, Valence, France
[12] Grp Etude Lymphomes Folliculaires, Namur, Belgium
[13] Dana Farber Canc Inst, Boston, MA 02115 USA
[14] Schering Plough Res Inst, Kenilworth, NJ USA
[15] Osped Civico, Lugano, Switzerland
[16] European Inst Oncol, Milan, Italy
关键词
D O I
10.1200/JCO.1998.16.7.2339
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: To evaluate the trade-off of toxicity versus improved clinical outcome with interferon alfa-2b (IFN) administered concomitantly with a doxorubicin-containing regimen for the treatment of advanced follicular lymphoma. Patients and Methods: A quality-of-life-adjusted survival analysis (Quality-Adjusted Time Without Symptoms or Toxicity [Q-TWiST]) was applied to the Groups d'Etude des Lymphomes Folliculaires (GELF) trial 86, which compared a regimen of cyclophosphamide, doxorubicin, teniposide, and prednisone (CHVP) versus CHVP plus IFN in 242 patients with confirmed follicular lymphoma. CHVP was administered monthly for 6 months then every other month for 12 months. The IFN dosage was 5 x 10(6) U three times weekly far 18 months. Results: After a median follow-up duration of 72 months, the IFN group gained a mean of 12.3 months of progression-free survival (PFS) and 7.4 months of overall survival (OS), but also experienced additional time with grade 3 or worse toxicity compared with the CHVP group. Sensitivity analysis demonstrated that CHVP plus IFN provided ct greater amount of quality-adjusted survival regardless of the relative quality-of-life valuations placed on time with toxicity due to CVHP alone, time with toxicity due to CHVP plus IFN, and time following disease progression. this gain was significant (P < .05) in all cases except far patients who consider time with toxicity to have a low relative value and time following disease progression to have a high relative value. Conclusion: In patients with advanced follicular lymphoma, the clinical benefits of concomitant IFN can significantly offset the associated grade 3 or worse toxic effects. The magnitude of this clinical benefit depends on an individual patient's relative quality-of-life valuations for time with toxicity and time fallowing disease progression. (C) 1998 by American Society of Clinical Oncology.
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页码:2339 / 2344
页数:6
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