Review: Long-term Use Of Lymphoma Drug Extends Lives

Main Category: Lymphoma / Leukemia / Myeloma
Article Date: 15 May 2009 - 2:00 PDT

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A new Cochrane Library review confirms that years-long use of a drug called rituximab extends the lifespan of people with one of the milder forms of lymphoma.

The authors, at the Rabin Medical Center in Israel, suggest that doctors prescribe the drug, known by the brand name Rituxan, to patients whose disease returned after treatment or resisted therapy.

Clinicians have used the drug to treat the follicular lymphoma strain for some time and it has "really revolutionized how clinicians think about (the disease)," said epidemiologist James Cerhan, M.D., who is familiar with the review findings.

Fewer doctors are turning to a "watchful waiting" approach to patients and are instead prescribing rituximab, said Cerhan, professor and chair of the Division of Epidemiology at Mayo Clinic College of Medicine.

Follicular lymphoma, a type of non-Hodgkin's lymphoma, affects the body's immune system. The cause of the disease is unclear. Symptoms include swollen lymph nodes, fever, night sweats and weight loss.

Typically, the cancer is slow growing, and doctors often recommend that patients not undergo treatment because they can live for years with the condition.

"People who get it tend to be old and often die of other things," Cerhan said. "The flip side is that it can't be cured."

In the past, doctors considered the cancer difficult to treat because chemotherapy and radiation did not always work well. In about 40 percent of cases, they advised patients to engage in "watchful waiting" and just keep an eye on their health, Cerhan said.

However, rituximab has changed things during this decade. "Now, you're seeing less and less of that, even though there's a significant group that is still being watched," he said.

Doctors use the intravenous drug to treat lymphoma and rheumatoid arthritis. In lymphoma patients, the drug binds to certain types of white blood cells in the immune system and kills them, said review lead author Dr. Liat Vidal. "But it binds more efficiently to cancer (cells) so it harms them more than it harms the good, healthy ones," Vidal said.

According to the review authors, studies have shown that the drug helps people with follicular lymphoma live longer without symptoms, but it was not clear if it extends their lifespan.

To resolve that question, the authors looked at five studies examining the long-term use of rituximab.

The new review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The researchers looked at five studies with 1,056 patients and focused on four with 895 patients to determine how the drugs affected survival. On average, the studies followed patients for three years. The review authors combined the statistics from the four studies into a meta-analysis. They found that those who took rituximab were 40 percent less likely to die in that period than those who did not, Vidal said.

Patients on rituximab did have more infections than those who did not take the drug. Still, Vidal said that all patients with follicular lymphoma that has recurred or that is resistant to treatment should receive the drug unless they get life-threatening infections during treatment.

"It gives hope for patients with follicular lymphoma as it prolongs the time until relapse and the next treatment and prolongs survival," Vidal said.

Still, some patients do not respond to rituximab, said Cerhan, the Mayo Clinic doctor. He serves on an external scientific advisory board that assists Genentech, the manufacturer of rituximab, as it studies follicular lymphoma.

Rituximab is not cheap. Still, a study in the June 2008 issue of the journal Clinical Lymphoma Myeloma determined that it is cost-effective to give the drug to patients, ages 65 to 70, who have relapsed twice. It cost almost $20,000 for each "quality-adjusted" year of life gained by the treatment, but the researchers wrote that is a cost "generally acceptable to the U.S. health care system."

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions

Vidal L, et al. Rituximab as maintenance therapy for patients with follicular lymphoma. Cochrane Database of Systematic Reviews Issue 2, 2009.

Source: Health Behavior News Service