Tucidinostat plus R-CHOP in untreated MYC/BCL2 double-expressor diffuse large B-cell lymphoma：topline efficacy and safety results from the randomized phase 3 DEB study
Year: 2025
Type: conference-abstract
Abstract: INTRODUCTION Epigenetic dysregulation is frequently associated with the pathogenesis and progression of diffuse large B-cell lymphoma (DLBCL). Tucidinostat (formerly known as chidamide), a subtype-selective histone deacetylase (HDAC) inhibitor, exerts epigenetic modulation of aberrant gene expression, a hallmark of various malignancies. Phase 2 studies suggest that tucidinostat combined with R-CHOP (CR-CHOP) has promising activity in double-expressor lymphoma (DEL), a subtype characterized by MYC and BCL2 co-expression that is historically associated with poor clinical outcomes. METHODS We conducted a randomized, double-blind, placebo-controlled, phase 3 trial (DEB) to evaluate the efficacy and safety of tucidinostat plus R-CHOP in comparison with R-CHOP in previously untreated DEL patients. Patients were randomly assigned in a 1:1 ratio to receive 20 mg oral tucidinostat or matching placebo plus six cycles of R-CHOP. Patients who had complete response (CR) after combination therapy received either tucidinostat or placebo treatment, with a maximum duration of 24 weeks. The primary end point was investigator-assessed event-free survival (EFS). Secondary end points included CR rate evaluated at the end of combination treatment, progression-free survival (PFS), disease-free survival (DFS), overall survival (OS) and safety. RESULTS A total of 423 patients were enrolled and randomized, with 211 assigned to the tucidinostat group and 212 to the placebo group. At the data cutoff date (June 26, 2025), with a median follow-up of 44.9 months (95%CI, 43.8-46.6), patients receiving tucidinostat plus R-CHOP had significantly improved EFS compared with those receiving placebo plus R-CHOP. The tucidinostat group demonstrated a 28% lower risk of disease progression, relapse after CR, death, or initiation of new therapy for residual disease (stratified hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.54 to 0.96; P=0.02). EFS rates favored tucidinostat at 2 years (60.3% vs 50.5%) and 3 years (56.8% vs 47.7%). The CR rate at the end of combination treatment was 73.0% (95% CI, 66.6-78.5) in the tucidinostat group versus 61.8% (95% CI, 55.1-68.1) in the placebo group, with an adjusted between-group difference of 11.1% (95% CI, 2.3-20.0; P=0.01). Overall, the tucidinostat plus R-CHOP regimen demonstrated a generally well tolerated safety profile, consistent with the known toxicity patterns of the individual agents. The incidence of ≥ grade 3 hematologic adverse events was generally higher in the tucidinostat group than the placebo group, but most patients were able to tolerate and complete the planned treatment cycles. No significant cardiac toxicity, hepatotoxicity, or nephrotoxicity were observed in both groups. CONCLUSION In previously untreated patients with DEL, the addition of tucidinostat to R-CHOP significantly improved EFS and increased the CR rate compared with R-CHOP alone, with no unexpected safety concerns. (Funded by Shenzhen Chipscreen Biosciences; ClinicalTrials.gov number, NCT04231448).
Source: Blood
Authors: Wei Li Zhao, Jun Zhu, Pengpeng Xu, Yuqin Song, Jianzhen Shen, Qingqing Cai, Hui Zhou, Liling Zhang, Ying Xiang, Xiuhua Sun, Wei Yang, Zhihua Yao, Hongmei Jing, Shujuan Wen, Jie Jin, Hongwei Xue, Hong Cen, Kaiyang Ding, Zhengming Jin, Lihong Liu, Xiaojing Xing, Lanfang Li, Ming Hou, Lin LIU, Mingzhi Zhang, Wenyu Li, Ou Bai, Ru Feng, Zunmin Zhu, Huijing Wu, Liping Su, Li Gao, Fei Li, Wenrong Huang, Peng Liu, Xiaojing Yan, Ying Zhao, Hang Su, Xielan Zhao, Rong FU, Hong Liu, Wenyu Shi
Institutions: Shanghai Jiao Tong University, Ruijin Hospital, Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, State Key Laboratory of Medical Genomics, Peking University, Peking University Cancer Hospital, Union Hospital, Sun Yat-sen University, Sun Yat-sen University Cancer Center, Hunan Cancer Hospital, Huazhong University of Science and Technology, Chongqing University, Chongqing Cancer Hospital, Dalian Medical University, Second Affiliated Hospital of Dalian Medical University, China Medical University, Henan Cancer Hospital, Peking University Third Hospital, Xinjiang Medical University, First Affiliated Hospital Zhejiang University, Zhejiang University, Affiliated Hospital of Qingdao University, Guangxi Medical University, Tumor Hospital of Guangxi Medical University, First Affiliated Hospital of Soochow University, Hebei Medical University, Fourth Hospital of Hebei Medical University, The Affiliated Yongchuan Hospital of Chongqing Medical University, Liaoning Cancer Hospital & Institute, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Shandong University, Qilu Hospital of Shandong University, First Affiliated Hospital of Zhengzhou University, Guangdong Provincial People's Hospital, First Hospital of Jilin University, Nanfang Hospital, Southern Medical University, Henan Provincial People's Hospital, Hubei Cancer Hospital, Shanxi Provincial Cancer Hospital, Army Medical University, Nanchang University, First Affiliated Hospital of Nanchang University, Chinese PLA General Hospital, Chinese People's Liberation Army, Fudan University, First Hospital of China Medical University, First People's Hospital of Foshan, Central South University, Xiangya Hospital Central South University, Tianjin Medical University General Hospital, Nantong University, Affiliated Hospital of Nantong University
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7108446948
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