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by Dr. C.H. Weaver M.D. updated 2/2019

According to a research published in the journal Blood, the addition of Rituxan® (rituximab) to the chemotherapy combination referred to as CVP improves anti-cancer response rates and time to cancer progression, but not overall survival compared to CVP alone as initial treatment in patients with follicular lymphoma. However, longer follow-up may provide a difference in long-term survival outcomes.

Follicular lymphoma is a type of non-Hodgkin’s lymphoma (NHL), which is a form of cancer that begins in the cells of the lymph system. The lymph system includes the spleen, thymus, tonsils, bone marrow, lymph nodes and circulating immune cells. The main cells in the lymph system are lymphocytes, of which there are two types: B and T-cells. Each of these cells has a very specific function in aiding the body to fight infection. NHL is characterized by the excessive accumulation of atypical (cancerous) lymphocytes. These lymphocytes can crowd the lymph system and suppress the formation and function of other immune and blood cells. While NHL is categorized by the type of lymphocyte it involves, it is also further defined by the rate at which the cancer grows, based on the appearance of the cells under a microscope. Follicular lymphoma is a low-grade or indolent lymphoma that is slow growing.

Rituxan® is a monoclonal antibody that is FDA approved for the treatment of B-cell NHL. B-cell NHL is the most common type of NHL, in which the cancer affects the immune cells called B-cells. Rituxan® is made through laboratory processes to bind to a specific site on B-cells. This binding action stimulates the immune system to attack the cell to which Rituxan® is bound. In addition, Rituxan® may possess some direct anti-cancer activity, killing the cell through speculated processes to which it is bound. Results from previous trials have indicated that Rituxan® in addition to chemotherapy may improve anti-cancer response rates and time to cancer progression; however, its effects on overall survival have not yet been confirmed.

A recent clinical trial involving multiple institutions was recently conducted to compare the addition of Rituxan® to CVP (Cytoxan®, Oncovin® and prednisone), to CVP only in the treatment of follicular lymphoma. This trial included 322 patients with advanced follicular lymphoma who had not received prior therapy. Patients were treated with either Rituxan ®/CVP or CVP only. Anti-cancer responses were achieved in 81% of patients treated with Rituxan®/CVP, and only 57% of patients treated with CVP alone. At approximately 30 months follow-up, the time to cancer progression was significantly improved in the group of patients treated with Rituxan®/CVP (32 months) compared to the group treated with CVP only (15 months). At 30 months, overall survival was 89% for patients treated with Rituxan®/CVP, compared to 85% for those treated with CVP only. The addition of Rituxan® to CVP was well tolerated.

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The researchers concluded that the addition of Rituxan® to CVP improves anti-cancer responses and time to cancer progression as initial treatment for patients with advanced follicular lymphoma. Overall survival; however, was not improved with the addition of Rituxan®, and ongoing studies are comparing initial treatment with Rituxan® and chemotherapy to treatment with Rituxan® once patients have a cancer recurrence. Patients with follicular lymphoma should discuss their individual risks and benefits of treatment including Rituxan® with their physician.

Reference: Marcus R, Imrie K, Belch A, et al. CVP chemotherapy plus rituximab compared to CVP as first-line treatment for advanced follicular lymphoma. Blood. 2005;105:1417-1423.

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