According to results recently published in the Journal of the American Academy of Dermatology, Rituxan® (rituximab) injected directly into sites of cancer in the skin appears to be a promising treatment regimen for patients with cutaneous B-cell lymphoma.

Non-Hodgkin’s lymphoma (NHL) begins in the cells of the lymph system, which includes the spleen, thymus, tonsils, bone marrow, lymph nodes and circulating immune cells. The main cells in the lymph system are lymphocytes. Two types of lymphocytes exist-B and T-cells-and each has a specific function in aiding the body to fight infection. NHL is characterized by the excessive accumulation of atypical (cancerous) lymphocytes. These cells can crowd the lymph system and suppress the formation and function of other immune and blood cells. NHL is categorized by the type of lymphocyte it involves and is further defined by the rate at which the cancer grows. A cell’s appearance under a microscope indicates its rate of growth. Low-grade or indolent lymphoma refers to NHL that is slow growing, and high-grade lymphoma refers to NHL that is aggressive and fast-growing. Cutaneous B-cell lymphoma refers to NHL that affects the skin.

One agent commonly used to treat B-cell lymphoma is Rituxan. Rituxan is a monoclonal antibody (protein) that binds to B-cells in the body. The binding action is thought to stimulate the immune system to kill the cells to which Rituxan is bound, as well as provide some direct killing effects itself. Rituxan is typically given into a vein (systemically).

Researchers in Austria recently evaluated data regarding the effectiveness of injecting Rituxan directly into the sites of cancer (intralesionally) in the skin in patients with cutaneous B-cell lymphoma. The data included nine patients-seven were treated intralesionally with Rituxan, while two were treated systemically with Rituxan. In six of the seven patients treated with intralesional Rituxan, detectable cancer completely disappeared (complete remission), and cancer partially shrank in the remaining patient. At 27-months follow-up, one patient’s cancer had recurred near the site of the original cancer; at 12- and 14-months follow-up, two patients developed a cancer recurrence at other body sites. Overall, no severe side effects were reported. The seven treated with intralesion Rituxan were able to receive significantly lower doses than the two patients treated with systemic Rituxan.

Researchers concluded that intralesion Rituxan may provide promising results at low doses for the treatment of cutaneous B-cell NHL. However, future clinical trials are necessary to provide a comparison between intralesion and systemic administration of Rituxan, as well as the effectiveness of a combination of both treatment approaches. Patients diagnosed with cutaneous B-cell lymphoma may wish to speak with their physician regarding their individual risks and benefits of participating in a clinical trial further evaluating intralesion Rituxan or other novel therapeutic approaches. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (www.cancer.gov) and www.cancerconsultants.com.

Reference: Fink-Puches R, Wolf I, Zalaudek I, et al. Treatment of primary cutaneous B-cell lymphoma with rituximab. Journal of the American Academy of Dermatology. 2005; 52:847-853.

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