Results recently published in the New England Journal of Medicine provides further evidence that long-term survival may be improved with the addition of Rituxan™ to the chemotherapy combination consisting of cyclophosphamide, doxorubicin, Oncovin® and prednisone in elderly patients with aggressive B-cell non-Hodgkin’s lymphoma.

NHL is a cancer of the lymph tissue, which is part of the body’s immune system. Lymph tissue is present in lymph nodes, lymph vessels, blood and bone marrow, which exist throughout the body. It is also present in organs such as the thymus, tonsils and spleen. 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. The large majority of NHL cases involves cancer of the B-lymphocytes and characterized by the excessive accumulation of these atypical cells. This results in overcrowding of blood and lymph tissue, suppressing the formation and function of blood and immune cells that are normally present. Additionally, the cancerous lymphocytes themselves do not function normally, leading to a further decrease the body’s ability to fight infection. The standard chemotherapy combination for elderly patients with this disease consists of cyclophosphamide, doxorubicin, Oncovin® and prednisone, often called CHOP.

Rituxan™ is a monoclonal antibody that has shown promising results when used in the treatment of some hematologic (blood/lymph) cancers. Monoclonal antibodies are proteins that can be made in the laboratory and are designed to recognize and bind to very specific cells. Rituxan™ is a monoclonal antibody that binds to proteins on the surface of B-lymphocytes, thereby stimulating the immune system to attack and kill the cancerous B-cells. A significant benefit of this approach is that Rituxan™ only targets cancer cells (B-cells), thus sparing healthy cells from destruction. This is in contrast to chemotherapy or radiation, which do not differentiate between cancer cells and healthy cells in the body, a characteristic leading to potentially destructive side effects. Studies have demonstrated that the combination of Rituxan™ and chemotherapy produces outcomes superior to chemotherapy alone for some types of NHL, and is the standard treatment for these diseases in younger patients.

A large clinical trial evaluating CHOP plus Rituxan™ in elderly patients (over 60 years) previously demonstrated that this treatment regimen improved anti-cancer responses and survival compared to CHOP alone as initial therapy. The researchers that conducted this trial have recently reported longer follow-up data of these patients. Eighteen months following treatment, the rate of cancer-free survival was 76% for patients treated with CHOP plus Rituxan™, compared to only 64% for patients treated with CHOP alone. Two years following treatment, 57% of patients treated with CHOP plus Rituxan™ did not experience progression of cancer, compared to only 37% of patients treated with CHOP alone. Overall survival at two years after therapy was 70% in the group of patients treated with CHOP plus Rituxan™, compared to only 57% in the group of patients treated with CHOP alone. The addition of Rituxan™ to the treatment regimen was well tolerated in these elderly patients.

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These results clearly demonstrate that the combination of Rituxan™ plus CHOP may increase long-term cancer-free survival and overall survival in elderly patients compared to the treatment of CHOP alone for aggressive NHL. Clinical trials are also ongoing to determine the optimal dose and duration of Rituxan™ therapy in combination with chemotherapy. Although Rituxan™ has proven in clinical trials to benefit patients with aggressive NHL when used in combination with CHOP, 40% of eligible NHL patients are still not being offered treatment with Rituxan™.

Patients 60 years or older with NHL may wish to speak with their physicians about the use of Rituxan™ or the risks and benefits of participating in a clinical trial utilizing other promising therapies. Two sources of information about ongoing clinical trials that can be discussed with a doctor include the comprehensive, easy-to-use clinical listing services provided by the National Cancer Institute ( and also performs personalized clinical trial searches on behalf of patients. (New England Journal of Medicine, Vol 346, No 4, pp 235-242, 2002)

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