Statins may reduce the effectiveness of Rituxan® (rituximab) in treatment of non-Hodgkin’s lymphoma (NHL), according to a recently published article in PLoS Med (the Public Library of Science journal).
Non-Hodgkin’s lymphoma occurs when cancerous cells arise from cells of the lymphatic system, which includes the spleen, thymus, tonsils, bone marrow, lymph nodes, and circulating immune cells. As a major part of the immunes system, two of the lymphatic system’s primary functions are to maintain fluid balance and produce cells called lymphocytes, which fight infection.
Lymphocytes are the main cells of the lymph system and are classified into two forms: B- and T-cells. Each of these cells has specific functions to help the body fight infection. B-cells, which are white blood cells, are the cells most commonly affected by NHL.
Rituxan is an agent that is targeted against specific components on B-cells, referred to as CD20 antigens. Rituxan binds to the CD 20 antigens and stimulates the immune system to attack the B-cells. As well, Rituxan is thought to possess some direct cancer-killing activity; specifically, it may destroy the cell to which it is bound.
Rituxan is one of the most commonly used agents in the treatment of several types of NHL, as well as some leukemias. Rituxan is often combined with chemotherapy to increase anticancer activity. Rituxan, however, may also be used as a single agent and is also being extensively evaluated in clinical trials for the treatment of various diseases.
Statins, or cholesterol-lowering drugs, have demonstrated anticancer activity in some patients with cancer. These drugs are being evaluated for cancer prevention and treatment for certain types of cancer.
Researchers from Poland recently conducted a clinical trial to evaluate the potential effects of the combination of Rituxan and statins in NHL. Through laboratory processes, NHL cells, Rituxan, statins, and immune cells were mixed together and analyzed.
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- Statins were found to change the composition and structure of CD 20 antigens.
- Rituxan was not able to bind to the altered CD 20 antigens and therefore could not produce its anticancer effects.
The researchers concluded that statins appear to alter the shape of CD 20 antigens, reducing the ability of Rituxan to bind to B-cells. Because these results may have important clinical implications, future studies regarding the combined use of statins and Rituxan are warranted.
Patients with NHL who are taking statins and Rituxan may wish to speak with their physician regarding their individual risks and benefits of this combination or the participation in a clinical trial further evaluating combined use of Rituxan and statins. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (www.cancer.gov) and www.eCancerTrials.com.
**Reference:**Winiarska M, Bil J, Wilczek E, et al. (2008) Statins impair antitumor effects of rituximab by inducing conformational changes of CD20. PLoS Med. 2008;5:e64 doi:10.1371/journal.pmed.0050064.
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