Compared with a watchful-waiting strategy, treatment with Rituxan® (rituximab) appears to delay the need for chemotherapy among patients with Stage II-IV, asymptomatic, non-bulky follicular lymphoma. These preliminary results were presented at the 52nd annual meeting of the American Society of Hematology (ASH).

Follicular lymphoma is an indolent (slow-growing) type of non-Hodgkin’s lymphoma. It involves a type of white blood cell known as a B cell. Patients without symptoms may be managed with a watchful-waiting approach in which chemotherapy is delayed until the cancer progresses.

Rituxan is a targeted therapy that binds to a marker known as CD20 on the surface of B cells. This binding prompts the immune system to destroy the cell, and may also have direct anticancer effects on the cell. Rituxan is commonly used in the treatment of non-Hodgkin’s lymphoma, and more recent studies have shown that it’s also active against chronic lymphocytic leukemia.

To evaluate whether initial treatment with Rituxan can delay the need for chemotherapy among patients with follicular lymphoma, researchers funded by Cancer Research UK conducted a study among 462 patients with Stage II, III, or IV, asymptomatic follicular lymphoma.

Patients were assigned to one of three treatment groups: 1) watchful waiting; 2) Rituxan once a week for four weeks; or 3) Rituxan once a week for four weeks followed by maintenance therapy with Rituxan (Rituxan given every two months for two years). Three years into the study it became apparent that Rituxan maintenance therapy improved efficacy, and group 2 (Rituxan without maintenance) was discontinued.

Patients have now been followed for a median of 34 months.

  • Patients in the Rituxan groups were less likely to require new therapy (chemotherapy or radiation therapy) than patients in the watchful-waiting group. The percent of patients who have not required new therapy is 49% in the watchful-waiting group, 80% in the group that got Rituxan without maintenance therapy, and 91% in the group that got Rituxan plus maintenance therapy.
  • At this point, there is no difference in overall survival among the three groups.

In a prepared statement, the lead author of the study noted, “These results will increase the options for the management of newly diagnosed patients with advanced asymptomatic follicular lymphoma, and it is likely that upfront [Rituxan] therapy will prove popular with patients when compared with a watchful-waiting approach.”

Reference: Ardeshna KM, Smith P, Qian W et al. An intergroup randomised trial of rituximab versus a watch and wait strategy in patients with stage II, III, IV, asymptomatic, non-bulky follicular lymphoma (grades 1, 2 and 3a). A preliminary analysis. Presented at the 52nd annual meeting of the American Society of Hematology. Orlando, FL, December 4-7, 2010. Abstract 6.

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