The Pharmaceutical Journal
Vol 268 No 7183 p123-130
2 February 2002

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Benefits of adding rituximab confirmed

Adding rituximab (MabThera) to the standard treatment for patients with diffuse large-B-cell lymphoma results in an increased complete-response rate and prolongs event-free and overall survival, a new study confirms (New England Journal of Medicine 2002;346:235).

Professor Bertrand Coiffier, head of the department of haematology, Hospices Civiles de Lyon, France, and colleagues compared standard CHOP chemotherapy (see Panel) with CHOP chemotherapy plus rituximab in 399 previously untreated elderly patients (aged 60 to 80 years). They found that 76 per cent of patients treated with CHOP plus rituximab had a complete response compared with 63 per cent of patients receiving CHOP alone (P=0.005). At two years, 70 per cent of patients treated with CHOP plus rituximab were alive, compared with 57 per cent of those who did not receive rituximab.

"Previously, standard chemotherapy had only a 30 to 40 per cent cure rate in aggressive non-Hodgkin's lymphoma [the most common form of diffuse large-B-cell lymphoma], a disease that can be rapidly fatal. The complete remission rates seen with this new combination are encouraging and indicate a real change in the way this disease can be treated from now on," Professor Coiffier said.

In an accompanying editorial, Dr Bruce Cheson, National Cancer Institute, Bethesda, Maryland, said that longer follow up times are needed to show that the advantage conferred by rituximab persists (ibid p280). "The difference between the survival curves begins to shrink at 2.5 years and will continue to shrink as older patients die from the disease, complications of therapy, and age-related conditions," he said. He added that more patients treated with CHOP plus rituximab died from infection, cachexia or cardiac disease during complete remission and that the relation between these events and treatment was unclear.

Rituximab is a chimeric monoclonal antibody against CD20, a surface antigen on both normal and neoplastic B lymphocytes. Roche, manufacturer of the drug, expects rituximab to receive European approval to treat aggressive non-Hodgkin's lymphoma this month.

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