Addition of rituximab to standard regimen may benefit lymphoma patients

By Emma Hitt, PhD

NEW YORK (Reuters Health) – The addition of rituximab, a chimeric monoclonal antibody against the CD20 B-cell antigen, to a standard chemotherapy regimen may benefit elderly patients with diffuse large-B-cell lymphoma, a European study shows.

Diffuse large-B-cell lymphoma is the most common type of non-Hodgkin's lymphoma and accounts for approximately 40% of new lymphoma cases, according to the report in the January 24th issue of The New England Journal of Medicine.

CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) is the standard chemotherapy for these patients, but only about half completely respond to treatment, and only about one third survive for 3 years after treatment.

Attempts have been made to boost the effectiveness of CHOP by adding other drugs, but the resulting increase in toxicity is not well tolerated, especially by elderly patients, according to the investigators.

Dr. Bertrand Coiffier of the Hospices Civils de Lyon, France, and colleagues wanted to see if elderly patients would benefit from the addition of rituximab to the CHOP regimen.

Dr. Coiffier and colleagues recruited about 400 patients with diffuse large-B-cell lymphoma between the ages of 60 and 80. All of them received the standard CHOP therapy, but about half also received rituximab.

Side effects were similar between the two groups, but 76% of the patients taking rituximab completely responded to treatment compared with 63% of the group on CHOP only.

Furthermore, at 2-year follow-up, the relapse and death rate appeared to be significantly reduced in the rituximab group compared with the CHOP-only group, the researchers found.

"This new combination will help to cure a large fraction of patients who did not respond completely to chemotherapy," Dr. Coiffier told Reuters Health, "and for that, it is a great advance for lymphoma patients.

"But it will not cure all patients," he continued. "Thus, continuing research is necessary."

In a related editorial, Dr. Bruce D. Cheson of the National Cancer Institute in Bethesda, Maryland points out that "a treatment with efficacy in one type of lymphoma may not necessarily be beneficial in other kinds of lymphoma."

But in a comment to Reuters Health, he said that these findings were "unexpected, but very welcome, as it is the first regimen to improve survival in this group of patients in more than 20 years."

According to Dr. Cheson, data from a US trial involving over 600 patients receiving rituximab and CHOP should be available later this year. "If these data confirm the findings of this trial, then we will certainly feel secure that an important breakthrough has been made," he said.

N Engl J Med 2002;346:235-242,280-281.

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