Campath® + Rituxan has Significant Activity in Newly Diagnosed CLL
by Dr. C. H. Weaver M.D. update 1/2018
Campath (alemtuzumab) is a monoclonal antibody that is targeted against B-cells. It has been designed to bind to specific sites on B-cells and cause the immune system to attack the cells to which it is bound.
Campath is a fully human monoclonal antibody that selectively targets the CD52 antigen, which is expressed more prominently on malignant lymphocytes than other cells. The binding of Campath stimulates destruction of the malignant lymphocytes and reduction or elimination of cancerous cells throughout the bone marrow, blood and lymph system.
Researchers from the European Union conducted a clinical trial to directly compare Campath to chlorambucil for the treatment of CLL. Chlorambucil is a chemotherapy agent that historically was commonly used for CLL. This trial included 297 patients who had not received prior therapy.
- Anticancer responses were achieved in 83% of patients treated with Campath and 55% of patients treated with chlorambucil.
- Progression-free survival was also significantly improved among patients treated with Campath compared with those treated with chlorambucil.
- Side effects were similar between the two groups of patients; infusion-related cytomegalovirus occurred more frequently with Campath, while nausea and vomiting occurred more frequently with chlorambucil.
The researchers concluded that Campath provides significant improvements in anticancer responses and progression-free survival compared with chlorambucil when used as initial therapy for CLL.(1)
The addition of Rituxan® (rituximab) to Campath® appears to enhance anticancer activity in patients with chronic lymphocytic leukemia who have a poor prognosis.
Chronic lymphocytic leukemia (CLL) is the most common form of adult leukemia. The American Cancer Society estimates that approximately 8,000 people will be diagnosed with CLL this year. Currently, there are approximately 60,000 people in the U.S. living with CLL.
CLL is characterized by the production of atypical lymphocytes. Lymphocytes are specialized immune cells that exist in two forms: B- and T-cells. These cells are produced in the bone marrow and each serves a specific function in aiding the body fight infection.
The large majority of CLL cases involve mature B-lymphocytes that tend to live much longer than normal. B-lymphocytes accumulate in the blood, bone marrow, lymph nodes, and spleen. This results in overcrowding of these areas and suppression of the formation and function of blood and immune cells. Additionally, the cancerous lymphocytes themselves do not function normally, leading to a further reduction in the body’s ability to fight infection.
Rituxan is a monoclonal antibody that is targeted against B-cells. It has been designed to bind to specific sites on B-cells and cause the immune system to attack the cells to which it is bound. Campath is another monoclonal antibody that is also targeted against B-cells, however the specific components of B-cells to which Campath binds are different from those of Rituxan. There are additional biological properties of both Rituxan and Campath, which are still being evaluated, that may also destroy B-cells. The combination of Rituxan and Campath is being studied in clinical trials.
Researchers conducted a clinical trial evaluating the combination of Rituxan and Campath in the treatment of patients with CLL who were considered to have a poor prognosis following standard therapies. This trial included 10 patients who had not received prior therapy.
- All patients achieved a complete disappearance of detectable cancer in their circulating blood and bone marrow (spongy material inside large bones).
- 70% of patients also achieved a complete disappearance of detectable cancer in their lymph nodes.
- The main side effect was low levels of immune cells.
The researchers concluded that the treatment combination consisting of Rituxan and Campath appears to produce promising results for patients with CLL who have a poor prognosis. However, this study will continue in order to determine the long-term effects of this treatment.
Campath can also safely and effectively be combined with Fludara and other chemotherapy combination for managing CLL.(3)
- Hillmen P, Skotnicki A, Robak t, et al. Alemtuzumab compared with chlorambucil as first-line therapy for chronic lymphocytic leukemia. Journal of Clinical Oncology [early online publication]. November 5, 2007. DOI: 10.1200/JCO.2007.12.9098.
- Frankfurt O, Hamilton E, Rosen ST. Pilot Trial of Alemtuzumab/Rituximab for CLL. Oral presentation by Dr. Rosen at the 14th Annual Meeting of the Chemotherapy Foundation Symposium. New York, NY. November 8-11, 2006.
- Elter T, Gercheva-Kyuchukova L, Pylylpenko H et al. Fludarabine plus alemtuzumab versus fludarabine alone in patients with previously treated chronic lymphocytic leukaemia: a ramdomised phase 3 trial. Lancet Oncology. 2011;12:1204-13.