trialsTrialPositive

POLARIX

The trial that improved on R-CHOP for the first time in twenty years, by swapping vincristine for an ADC.

POLARIX, trial NCT03274492 sponsored by Roche and published in the New England Journal of Medicine in 2022, was the trial that improved on R-CHOP in untreated diffuse large B-cell lymphoma for the first time in twenty years, by swapping vincristine for the CD79b antibody-drug conjugate polatuzumab vedotin. It randomised 879 patients aged 18 to 80 with IPI 2 to 5 to Pola-R-CHP or R-CHOP, met its primary progression-free survival endpoint at two years with the benefit holding at five years in the 2025 JCO update, while overall survival was not significantly different and safety was similar; benefit concentrated in ABC-type and higher IPI disease. Whether a progression benefit without a survival benefit justifies the regimen for every patient is the open question.

Setting

Untreated DLBCL, IPI 2-5, age 18-80: Pola-R-CHP vs R-CHOP

Phase

Phase 3

Sponsor

Roche

Registry

Headline result

2-year PFS 76.7% vs 70.2%, HR 0.73; 5-year OS HR 0.85 (NS).

Started

2017-11-16

Reported

2021

Enrolled

879 randomisedClinicalTrials.gov lists 1,000 participants (actual); the NEJM 2022 primary analysis randomised 879 patients (440 Pola-R-CHP, 439 R-CHOP).

Replication

Consistent with the phase 1b/2 GO29044 cohort; POLAR BEAR (elderly) and real-world series broadly concordant; no OS benefit at 5 years.

Outcomes

In plain words

What these results mean for people, not percentages

879 randomised

Progression-free survival at 2 yearsprimarysurrogate endpoint

76.7 vs 70.2 out of 100 alive without the cancer growing at 2 years with Pola-R-CHP compared with R-CHOP; 6.5 more per 100.
Roughly one extra person helped for every 15 treated. That is a rough figure taken from the two percentages, not a guarantee for any one person.
Put another way, the treated group had about 27 percent lower chance of the event at any given time (hazard ratio 0.73, likely range 0.57 to 0.95).

This is a surrogate endpoint: it measures the cancer being controlled or absent on scans and tests, which often, but not always, translates into living longer.

Progression-free survival at 5 yearssurrogate endpoint

64.9 vs 59.1 out of 100 alive without the cancer growing at 5 years with Pola-R-CHP compared with R-CHOP; 5.8 more per 100.
Roughly one extra person helped for every 17 treated. That is a rough figure taken from the two percentages, not a guarantee for any one person.
Put another way, the treated group had about 23 percent lower chance of the event at any given time (hazard ratio 0.77, likely range 0.62 to 0.97).

This is a surrogate endpoint: it measures the cancer being controlled or absent on scans and tests, which often, but not always, translates into living longer.

Overall survival at 5 yearssurvival endpoint

82.3 vs 79.5 out of 100 alive at 5 years with Pola-R-CHP compared with R-CHOP; 2.8 more per 100.
Roughly one extra person helped for every 36 treated. That is a rough figure taken from the two percentages, not a guarantee for any one person.
Put another way, the treated group had about 15 percent lower chance of the event at any given time (hazard ratio 0.85, likely range 0.63 to 1.15).

The likely range for the hazard ratio crosses 1, so the difference could be due to chance.
Overall survival counts deaths from any cause, so it is the most direct measure of whether a treatment helps people live longer.

Caveats

These results apply to the people the trial enrolled: Untreated DLBCL, IPI 2-5, age 18-80: Pola-R-CHP vs R-CHOP. People in a different situation may not see the same effect.

Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.

879 randomised.

Progression-free survival at 2 yearsprimary

HR 0.73 (0.57 to 0.95) · p = 0.02

Pola-R-CHP76.7 of 100

n = 440

R-CHOP70.2 of 100

n = 439

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Progression-free survival at 5 years

HR 0.77 (0.62 to 0.97)

Pola-R-CHP64.9 of 100

R-CHOP59.1 of 100

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Overall survival at 5 years

HR 0.85 (0.63 to 1.15)

Pola-R-CHP82.3 of 100

R-CHOP79.5 of 100

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Endpoint	Arm	n	Value	HR (95% CI)	p	Source
Progression-free survival at 2 yearsprimary	Pola-R-CHP	440	76.7%	0.73 (0.57 to 0.95)	0.02	link
Progression-free survival at 2 yearsprimary	R-CHOP	439	70.2%	0.73 (0.57 to 0.95)	0.02	link
Progression-free survival at 5 years	Pola-R-CHP	-	64.9%	0.77 (0.62 to 0.97)	-	link
Progression-free survival at 5 years	R-CHOP	-	59.1%	0.77 (0.62 to 0.97)	-	link
Overall survival at 5 years	Pola-R-CHP	-	82.3%	0.85 (0.63 to 1.15)	-	link
Overall survival at 5 years	R-CHOP	-	79.5%	0.85 (0.63 to 1.15)	-	link

Replication

Consistent with the phase 1b/2 GO29044 cohort; POLAR BEAR (elderly) and real-world series broadly concordant; no OS benefit at 5 years.

Key papers

rctJournal of Clinical Oncology 2026changed practice

Polatuzumab vedotin plus rituximab, gemcitabine, and oxaliplatin in relapsed or refractory diffuse large B-cell lymphoma: results from the phase III, randomized POLARGO trial

An option with a demonstrated survival benefit for transplant-ineligible relapsed diffuse large B-cell lymphoma, a group for whom very little has ever shown one. The fatal adverse event imbalance belongs in the conversation alongside the survival figure.

rctNew England Journal of Medicine 2022changed practice762 citations

POLARIX: swapping vincristine for the antibody-drug conjugate polatuzumab vedotin in first-line treatment of diffuse large B-cell lymphoma

POLARIX gave the first new first-line standard for DLBCL since rituximab was added to CHOP, and pola-R-CHP is now approved and widely used, especially in higher-risk or ABC-type disease. The gain is modest and survival is unchanged, so many clinicians still use R-CHOP in lower-risk or GCB-type patients. Cost and subgroup uncertainty drive ongoing debate.

Connected

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key papers

POLARIX: swapping vincristine for the antibody-drug conjugate polatuzumab vedotin in first-line treatment of diffuse large B-cell lymphoma Polatuzumab vedotin plus rituximab, gemcitabine, and oxaliplatin in relapsed or refractory diffuse large B-cell lymphoma: results from the phase III, randomized POLARGO trial