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Combining Rituxan and Chemotherapy: What are the Benefits?

Summary & Participants

Data shows show that combining Rituxan and chemotherapy can have good results for patients with NHL. But does that mean that all patients will benefit from this strategy? Does adding chemotherapy to Rituxan bring small gains at the price of increased discomfort? Join us as we discuss these and other questions with experts from the American Society of Hematology 2001 meeting.

Medically Reviewed On: June 26, 2008

Webcast Transcript

BRETT SCOTT: I'm Brett Scott in Orlando, Florida, where this year's American Society of Hematology meeting is currently underway. Rituxan was approved several years ago for the treatment of lymphoma but its use in therapy continues to evolve as new combinations of Rituxan and other medications are tested. Experts at the conference presented new data on this strategy and I had the chance to talk to them about their findings.

Dr. Goldstone, Rituxan was initially approved as a therapy to be used on its own. Why now is it also being used in combination with chemotherapy?

ANTHONY GOLDSTONE, MD: Like all other drugs they are looking at the initial effects of it come from its use as a single agent. It was shown to be active in lymphoma in a considerable number of patients, probably over half. But for some of them the effect wore off in due time, probably mostly over a few months or so.

Chemotherapy we know is traditionally effective in many types of lymphoma. And it's possible to add the two together for two reasons. First of all, they work in different ways. The antibodies in a different way from the chemotherapy so that patients not responding to one may respond to the other. Secondly, because there is no great toxicity from the antibody in terms of what it does to the hemopoietic system, that is the blood count.

BRETT SCOTT: What are the main differences between the addition of CHOP chemotherapy vs. the addition of fludarabine?

ANTHONY GOLDSTONE, MD: Well, CHOP and fludarabine are alternative regimens for the treatment of non-Hodgkin's lymphoma, particularly low-grade lymphoma. CHOP is a four-drug regimen and fludarabine is a single-agent regimen.

CHOP causes side effects in terms of toxicity to the patient -- sometimes a little bit of nausea and very rarely vomiting. And it's very aggressive on the blood count.

While fludarabine is a much more benign drug to take with few side effects, but it produces problems with the patient in terms of predisposing them perhaps to infection.

Now if you add Rituxan to the CHOP, you're not adding any extra toxicity because any of the toxicity comes from the CHOP. And hopefully, the problems with the blood count will be no more difficult than using CHOP alone.

If you add Rituxan to the fludarabine, you're adding a nontoxic agent to another nontoxic agent so the patient doesn't experience any difficulty. However, both those drugs, fludarabine and Rituxan lower the effects of the immune system. So one of the problems you may have is although you may improve the treatment of the lymphoma, those patients may be more susceptible to infection than with either drug alone.

BRETT SCOTT: Are these combination treatments suitable for all patients or all types of lymphoma?

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