Cancer Treatment Today » New Drugs

Azerra for mantle cell lymphoma

M Levin, MD — Sun, 31 Mar 2013 13:07:40 +0000

Azerra (ofatumumab) is a new antibiody against Chronic lymphocytic leukemia( CLL). Preclinical data suggest that it might be more effective than Rituxan in variety of lymphomas. In early clinical trials, ofatumumab demonstrated single-agent activity against chronic lymphocytic leukemia (CLL) and B-cell non-Hodgkin’s lymphomas. It was approved by the US Food and Drug Administration for the treatment of CLL that is resistant to both fludarabine and alemtuzumab. In In early clinical trials, ofatumumab demonstrated single-agent activity against CLL and a number of subtypes of B-cell non-Hodgkin’s lymphomas.

Not much is known about using this drug for mantle cell lymphoma. Preclinical comparisons make it appears superior to rituxumab but there are also studies in which it does not. A recent review noted that pre-clinical data suggest improved cell killing for ofatumumab compared with rituximab. Ofatumumab is in a clinical trial for Mantle cell lymphoma: Ofatumumab With or Without Bendamustine for Patients With Mantle Cell Lymphoma Ineligible for Autologous Stem Cell TransplantThis study is being done to understand how to treat Mantle Cell Lymphoma (MCL).

M. Magni presented an abstract in the 2011 ASH conference. It reported that chemotherapy with bendamustine and ofatumumab appears generally safe and well tolerated to date in MCL patients aged ≥ 65 years requiring treatment. Preliminary data about efficacy are encouraging: accrual is ongoing for further evaluation.

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Revlimid and Rituxan for lymphoma maintenance

M Levin, MD — Thu, 27 Sep 2012 11:54:59 +0000

Recent studies suggest that lenalidomide and rituxan are effective in relapsed or refractory lymphomas. Revlimid, in particular, shows effectiveness for maintenance in myeloma. Because both drugs are well tolerated, this created an interest in studying their effectiveness for maintenance. The idea behind maintenance therapy is to supress any remaining or dormant cells and to prolong time to the return of the diseae, or possibly to produce a cure. Currently, maintenance is not standard for most lymphomas, including Diffuse Large B Cell lymphoma. Lenalidomide alone is still in studies, for example, Maintenance Lenalidomide in Lymphoma, NCT01575860.

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Thalidomide or Lenalidomide and Rituximab for Mantle Cell Lymphoma

M Levin, MD — Tue, 19 Jun 2012 17:35:56 +0000

Thalidomide, lenalidomide and rituximab have no direct effect on MCL cells. However, both indirectly affect peripheral blood mononuclear cell-mediated cytotoxicity, and rituximab induces both complement-dependent and antibody-dependent cellular cytotoxicity (ADCC) against MCL cells. Rituximab-induced ADCC is enhanced by lenalidomide and thalidomide. In a 2004 series, thirteen patients of sixteen enrolled (81%) experienced an objective response, with 5 complete responders (31%). Median progression-free survival (PFS) was 20.4 months (95% confidence interval [CI], 17.3-23.6 months), and estimated 3-year survival was 75%. In patients achieving a complete response, PFS after rituximab plus thalidomide was longer than PFS after the preceding chemotherapy. Severe adverse events included 2 thromboembolic events and 1 grade IV neutropenia associated with thalidomide.Several similar studies show promise, but the combination of rituximab and thalidomide still requires investigation and is not currently recommended by any guidelines.

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