Frail, elderly patients with non-Hodgkin’s lymphoma who are not able to tolerate aggressive chemotherapy may benefit from treatment with the chemotherapy drug vinorelbine plus prednisone, according to a phase II study published in the journal Annals of Oncology.
Non-Hodgkin’s Lymphoma (NHL) is a form of cancer that begins in the cells of the lymph system, which includes the spleen, thymus, tonsils, bone marrow, lymph nodes, and circulating immune cells. Lymphocytes are the main cells in the lymph system and exist in two forms: B and T-cells. Each of these cells serves a specific function in aiding the body fight infection. In NHL, an excessive amount of atypical (cancerous) lymphocytes accumulates in the lymph system. These lymphocytes can crowd and suppress the formation and function of other immune and blood cells. NHL is categorized by the type of lymphocyte it involves and further defined by the rate at which the cancer grows. The appearance of the cells under a microscope indicates the growth rate. High-grade or aggressive NHL is the fastest growing, whereas low-grade or indolent lymphoma develops slowest.
Treatment for NHL, as for other cancers, may vary according to the health and preferences of the patient. Some patients, such as the frail or elderly, may not be able to tolerate the aggressive chemotherapy regimens that are most effective for treating NHL. Patients defined as frail include those who have severe diseases in addition to cancer, are not self-sufficient, or who are over the age of 80 years. While treatment options may be more limited for these patients, there is a need to provide treatment that, at a minimum, will relieve the symptoms of cancer. Researchers are therefore exploring treatment options that will be well tolerated by this population and will have some effect on the cancer or its symptoms.
To evaluate the effects of treatment with vinorelbine and prednisone among elderly, frail patients with intermediate or high-grade NHL, researchers in Italy enrolled 30 patients who were either over the age of 80 or over the age of 70 with other serious health problems. All were treated with vinorelbine and prednisone. Patients were not treated with Rituxan® (rituximab)-another NHL treatment that may have been well-tolerated by these patients-because it was not available at the time of the study.
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After treatment, 10% of patients experienced a complete disappearance of detectable NHL; half of these patients survived without detectable disease for at least 29 months. Thirty percent of patients experienced a partial reduction in detectable NHL after treatment. Adverse effects of treatment were generally mild.
The researchers conclude that although treatment with vinorelbine plus prednisone is less likely to produce complete disappearance of NHL than more aggressive chemotherapy, it was well tolerated by this elderly population. The researchers suggest that among NHL patients who are not candidates for aggressive chemotherapy, the combination of vinorelbine and prednisone may be considered for the temporary relief of NHL symptoms.
Reference: Monfardini S, Aversa SML, Zoli V et al. Vinorelbine and prednisone in frail elderly patients with intermediate-high grade non-Hodgkin’s lymphomas. Annals of Oncology. 2005;16:1352-1358.
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