Prevalence of Clarithromycin-Resistant Helicobacter pylori Strains in Gastric Mucosa-Associated Lymphoid Tissue Lymphoma Patients

Bilgilier, Ceren; Simonitsch‐Klupp, Ingrid; Kiesewetter, Barbara; Raderer, Markus; Dolak, Werner; Makristathis, Athanasios; Steininger, Christoph

doi:10.1055/s-0036-1584017

Cited by 1 publication

(1 citation statement)

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“…While initially having been included in most regimens applied for eradication of HP, the increasing rate of resistance to clarithromycin of various HP strains is becoming a problem. While a small study in Austria has shown the rate of clarithromycin-resistant HP strains to be roughly 13% in MALT lymphoma patients, 7 the small number of patients studied along with the fact that the overall resistance rate is among the highest in Europe has led to the recommendation that clarithromycin should no longer be used in a triplet HP-eradication therapy, while it is still recommended as part of quadruple therapies according to the Maastricht V consensus. 8,9 Emerging results have shown a surprisingly high direct antineoplastic activity of the macrolide in patients with MALT lymphoma, including heavily pretreated patients.…”

Section: Introductionmentioning

confidence: 99%

Treatment of mucosa associated lymphoid tissue lymphoma with a long‐term once‐weekly regimen of oral azithromycin: Results from the phase II MALT—A trial

Lagler

Kiesewetter

Dolak

et al. 2018

Hematological Oncology

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The macrolide clarithromycin has been reported as active for therapy of mucosa associated lymphoid tissue (MALT) lymphoma. Pharmacokinetic properties, however, require continuous daily intake over a prolonged period of time. As the macrolide azithromycin is characterized by a long half-life as well as potential antineoplastic activity in vitro, we have performed a phase II trial of long-term once-weekly oral azithromycin for treatment of MALT lymphoma. In a 2-stage-design, 16 patients (10 f/6 m) with histologically verified and measurable MALT lymphoma were included in the first phase of the trial, which could be expanded to a maximum of 46 patients depending on remissions in the first phase. Patients were given oral azithromycin 1500 mg once-weekly 4 times a month, and restaging was performed after 3 and 6 months. Two patients had gastric and 14 extragastric MALT lymphoma; 12/16 patients were treatment-naive and received azithromycin as first line treatment. Tolerance of this regimen was excellent, and 14/16 patients received 6 months of treatment as scheduled, while 1 patient each discontinued after 4 (progressive disease) and 1 cycle (personal reasons), respectively. The most commonly observed side effects were mild nausea (n = 8) and diarrhea (n = 4). Efficacy, however, was low as only 4/16 patients (25%) responded, with 2 complete and 2 partial remissions, 9 patients (56%) had stable disease, and 3 patients 19%) were rated as progressive disease. As the predefined activity of more than 7/16 patients responding was not reached, the study was stopped after 16 patients. Although long-term once-weekly oral azithromycin showed some antilymphoma activity, the response rate was below the predefined threshold of interest. However, based on our data, one cannot rule out suboptimal dosing in our study; attempts to study azithromycin at a different mode of application might be warranted in the future.

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Section: Introductionmentioning

confidence: 99%