Abstract
Rituximab combined with chemotherapy is the first-line induction therapy of CD20positive B-cell non-Hodgkin lymphomas (CD20+ B-NHL). Recently new anti-CD20 monoclonal antibodies (mAbs) have been developed, but their efficacy and safety compared with rituximab are still controversial. We aimed to assess the efficacy and safety of new anti-CD20 mAbs compared with rituximab in the induction therapy of CD20+ B-NHL with a systematic review and meta-analysis. We searched MEDLINE, Embase, and Cochrane Library for eligible randomised controlled trials (RCTs) that compared new anti-CD20 mAbs with rituximab in induction therapy of B-NHL. The primary outcomes are progression-free survival (PFS) and overall survival (OS), additional outcomes include event-free survival (EFS), disease-free survival (DFS), overall response rate (ORR), complete response rate (CRR) and incidences of adverse events (AEs). Time-to-event data were pooled as hazard ratios (HRs) using the generic inverse-variance method and dichotomous outcomes were pooled as odds ratios (ORs) using the Mantel-Haenszel method with their respective 95% confidence interval (CI). Eleven RCTs comprising 5,261 patients with CD20+ B-NHL were included. Compared with rituximab, obinutuzumab significantly prolonged PFS (HR 0.84, 95% CI 0.73-0.96, P = 0.01), had no improvement on OS, ORR, and CRR, but increased the incidences of serious AEs (OR 1.29, 95%CI 1.13-1.48, P < 0.001). Ofatumumab was inferior to rituximab in consideration of ORR (OR 0.73, 95% CI 0.55-0.96, P = 0.02), and had no significant differences with rituximab in regard to PFS, OS and CRR. 131I-tositumomab yield similar PFS, OS, ORR and CRR with rituximab. 90Y-ibritumomab tiuxetan increased ORR (OR 3.07, 95%CI 1.47-6.43, P = 0.003), but did not improve PFS, DFS, OS and CRR compared with rituximab. In conclusion, compared with rituximab in induction therapy of CD20+ B-NHL, obinutuzumab can significantly improves PFS but with higher incidence of AEs, ofatumumab decrease ORR, 90Y-ibritumomab tiuxetan increase ORR. Disclosures No relevant conflicts of interest to declare.
Highlights
Rituximab combined with chemotherapy is the first-line induction therapy of CD20 positive B-cell non-Hodgkin lymphomas (CD20+ B-Non-Hodgkin lymphomas (NHL))
In vitro studies have proved that obinutuzumab has more potent direct cell death (DCD) and more effective antibody-dependent cellular cytotoxicity (ADCC) to target cells compared with rituximab[11,12]
The results demonstrated that compared with rituximab, obinutuzumab had a significant improvement in progression-free survival (PFS) increased the incidences of various adverse events (AEs), and 90Y-ibritumomab achieved a higher overall response rate (ORR) without improvement of PFS
Summary
Rituximab combined with chemotherapy is the first-line induction therapy of CD20 positive B-cell non-Hodgkin lymphomas (CD20+ B-NHL). New anti-CD20 monoclonal antibodies (mAbs) have been developed, but their efficacy and safety compared with rituximab are still controversial. Compared with rituximab in induction therapy of CD20+ B-NHL, obinutuzumab significantly improves PFS but with higher incidence of AEs, ofatumumab decreases ORR, 90Y-ibritumomab tiuxetan increases ORR. Clinical trials which investigated whether obinutuzumab is superior to rituximab in the treatment of patients with other subtypes of B-NHL were performed, but the results are inconsistent. A lot of clinical trials have been performed to compare the efficacy and safety of multiple new anti-CD20 mAbs with rituximab for the treatment of B-NHL, but the results of these trials are inconsistent. This systematic review and meta-analysis aimed to assess the efficacy and safety of new anti-CD20 mAbs compared with rituximab in the induction therapy of CD20+ B-NHL
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