{"id":16033,"date":"2022-03-28T18:01:14","date_gmt":"2022-03-28T16:01:14","guid":{"rendered":"https:\/\/convergences.online\/hemato\/?p=16033"},"modified":"2024-12-11T14:57:52","modified_gmt":"2024-12-11T13:57:52","slug":"le-r-chop-toujours-roi","status":"publish","type":"post","link":"https:\/\/www.hematostat.net\/en\/le-r-chop-toujours-roi\/","title":{"rendered":"Le R-CHOP toujours roi ?"},"content":{"rendered":"
R\u00e9f. : HematoStat.net ; 3 (1) : R45<\/span><\/div>\n


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Tilly H, Morschhauser F, Sehn LH, Friedberg JW, Trn\u011bn\u00fd M, Sharman JP, et al. Polatuzumab Vedotin in Pr\u00e9c\u00e9dently Untreated Diffuse Large B-Cell Lymphoma. N Engl J Med. 27 janv 2022;386(4):351<\/span>\u2011<\/span>63.<\/span><\/i><\/div>\n
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R\u00e9sum\u00e9<\/h3>\n
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L\u2019\u00e9tude POLARIX, essai de phase 3 randomis\u00e9 contr\u00f4l\u00e9e contre placebo, \u00e9valuait le polatuzumab vedotin (pola)-R-CHP face au R-CHOP. \u00c9taient inclus des patients atteints de lymphome B diffus \u00e0 grandes cellules (LBDGC) de risque interm\u00e9diaire ou \u00e9lev\u00e9, \u00e2g\u00e9s de 18 \u00e0 80 ans et ayant un PS \u2264 2. Au total, 879 patients ont \u00e9t\u00e9 inclus : la survie sans progression (crit\u00e8re principal) \u00e9tait de 76,7 % dans le groupe pola-R-CHP contre 70,2 % dans le groupe R-CHOP (p=0,02). La survie \u00e0 2 ans n\u2019\u00e9tait pas statistiquement diff\u00e9rente entre les groupes.<\/div>\n
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Dans nos pratiques<\/h3>\n
Le pola, anticorps conjugu\u00e9 ciblant le CD79b, tente ici de d\u00e9tr\u00f4ner le R-CHOP comme standard de traitement des LBDGC en 1re <\/sup>ligne. Dans cette \u00e9tude, on observe une r\u00e9duction du risque de d\u00e9c\u00e8s ou de progression de la maladie dans le bras exp\u00e9rimental pola-R-CHP (en particulier si >60 ans, IPI \u00e9lev\u00e9s et sous-type ABC). N\u00e9anmoins, outre la question du co\u00fbt, ces r\u00e9sultats seront-ils suffisants pour l\u2019obtention de l\u2019AMM ou un suivi sup\u00e9rieur sera-t-il n\u00e9cessaire ?<\/div>\n
<\/div>\n

Critique m\u00e9thodologique<\/h3>\n

L\u2019essai clinique et la m\u00e9thodologie appliqu\u00e9e ont \u00e9t\u00e9 tr\u00e8s rigoureux, d\u2019une part car il s\u2019agit d\u2019un essai randomis\u00e9 en double-aveugle (le gold-standard<\/i>) sur une population relativement large, d\u2019autre part parce que les crit\u00e8res secondaires ont \u00e9t\u00e9 test\u00e9s de mani\u00e8re hi\u00e9rarchique, suivant les recommandations actuelles (une approche \u00e9tape par \u00e9tape qui permet de contr\u00f4leur le risque alpha). Les r\u00e9sultats concluent quant \u00e0 une am\u00e9lioration de la survie sans progression ou sans \u00e9v\u00e9nement mais pas de la survie globale. De plus, cette am\u00e9lioration en termes de PFS et d\u2019EFS survient, d\u2019apr\u00e8s les graphiques, apr\u00e8s 6 mois. La question de la suffisance des r\u00e9sultats sur le plan clinique est donc l\u00e9gitime.<\/p>\n<\/div><\/div><\/div><\/div><\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":16,"featured_media":14595,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[36],"tags":[],"ppma_author":[456],"class_list":["post-16033","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-revue-de-presse","author-alexis-genthon"],"aioseo_notices":[],"authors":[{"term_id":456,"user_id":16,"is_guest":0,"slug":"alexis-genthon","display_name":"Alexis GENTHON","avatar_url":{"url":"https:\/\/www.hematostat.net\/wp-content\/uploads\/2023\/06\/Capture-decran-2021-05-07-a-14.25.02.png","url2x":"https:\/\/www.hematostat.net\/wp-content\/uploads\/2023\/06\/Capture-decran-2021-05-07-a-14.25.02.png"},"first_name":"","last_name":"","user_url":"","description":"H\u00e9matologue.\r\nCorrespondance : H\u00f4pital Saint-Antoine \r\nService h\u00e9matologie clinique\r\n184 rue du Faubourg Saint-Antoine 75012 Paris."}],"_links":{"self":[{"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts\/16033","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/users\/16"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/comments?post=16033"}],"version-history":[{"count":1,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts\/16033\/revisions"}],"predecessor-version":[{"id":18215,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts\/16033\/revisions\/18215"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/"}],"wp:attachment":[{"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/media?parent=16033"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/categories?post=16033"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/tags?post=16033"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/ppma_author?post=16033"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}