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| |  NCCN: Rituximab Use Inserted Into New Lymphoma Guidelines By Ed Susman HOLLYWOOD, FL -- March 15, 2004 -- The anti-CD20 monoclonal antibody rituximab has been added into the National Comprehensive Cancer Network (NCCN) guidelines for the treatment of diffuse large B-cell and follicular cell lymphomas. "Rituximab has changed the way we are treating patients with b-cell lymphoma," said Myron Czuczman, MD, Associate Professor of Medicine and Assistant Member, Department of Immunology, University of Buffalo School of Medicine and Biomedical Sciences, New York, United States. He presented the updated guidelines for the treatment of lymphomas here December 13th at the NCCN's 9th Annual Conference Clinical Practice Guidelines & Outcomes Data in Oncology. The addition of rituximab into the treatment algorithm was the major change in the guidelines, he said. "We don't have one way of treating these patients," Dr. Czuczman said. For example, in addition to rituximab for treatment of follicular lymphoma, the guidelines also consider as first-line therapies chlorambucil, cyclophosphamide, CVP (cyclophosphamide, vincristine and prednisone) with or without rituximab, fludarabine with and without rituximab, FND (combination of fludarabine, mitoxantrone and dexamethasone) with or without rituximab, and CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) with or without rituximab. Second line therapies for follicular lymphoma include radioimmunotherapy, autologous transplant, allogenic transplant or chemo-immunotherapy. Dr. Czuczman said that findings from several clinical trials suggest longer event-free survival rates when rituximab is added to standard chemotherapy for follicular lymphoma. In addition to follicular lymphoma, the use of rituximab is included in the algorithms for treatment of diffuse large B-cell lymphoma, which with follicular lymphoma accounts for about two thirds of lymphoma-like diseases. Rituximab therapy is inserted into the guidelines for Stage I or Stage II lymphoma, following initial assessment of whether the patient has adverse risk factors or whether the disease is bulky or nonbulky. While the new guidelines differ from the previous set on the basis of these factors, the first treatment involves cycles of CHOP, either by itself or with rituximab. Dr. Czuczman explained that rituximab is a genetically engineered chimeric murine/human antibody that attaches to the aberrant B-cell and prevents it from replicating. While it has single-agent efficacy, Dr. Czuczman said its mechanisms of action are not cross-resistant with standard chemotherapy so it appears to have synergistic activity against cancer.
[Study title: Update: Non-Hodgkin's Lymphoma Guidelines]
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