Lay Summary: Rituxan is a promising drug for Hodgkin’s.
According to results recently published in the journal Blood, Rituxan® (rituximab) appears to be a promising agent in the treatment of some patients with recurrent Hodgkin’s. Monoclonal antibodies have recently emerged as therapeutic strategies for various cancers, particularly non-Hodgkin’s lymphomas. Monoclonal antibodies are proteins that are designed through laboratory processes to recognize and bind to specific protein and/or carbohydrate sequences (antigens) of a cell, such as a cancer cell. The binding of monoclonal antibodies to a cell often stimulates the immune system to initiate an attack against the cell and/or may cause the cell to die. Rituxan® is a monoclonal antibody approved for treatment of non-Hodgkin’s lymphoma (NHL) and binds to an antigen called CD 20. A small subset of patients with Hodgkin’s lymphoma (3% to 8%) has a type of cancer called CD 20 lymphocyte predominant Hodgkin’s lymphoma, characterized by a large proportion of their cancer cells expressing CD 20. Patients with CD 20 lymphocyte predominant Hodgkin’s lymphoma tend to have a higher rate of recurrence following standard therapy than other patients with Hodgkin’s lymphoma.
Researchers from Germany recently conducted a clinical trial to evaluate the effectiveness of Rituxan® in the treatment of recurrent Hodgkin’s lymphoma. The trial involved 14 patients with CD 20 lymphocyte predominant Hodgkin’s lymphoma, or Hodgkin’s lymphoma with over 30% of their cancer cells expressing CD 20. Patients were on average 9 years from diagnosis and had stopped responding to at least one prior therapy. Overall, 12 patients had an anti-cancer response to Rituxan®, with 8 patients achieving a complete disappearance of detectable cancer and 4 patients achieving a partial anti-cancer response. Two patients had progressive disease. One year following therapy, 9 of the 12 responding patients demonstrated no signs of cancer progression. Furthermore, at over 20 months following therapy, the average duration of responses has not yet been reached. Side effects were generally mild and moderate, allowing for the majority of patients to receive treatment on an outpatient basis.
The researchers concluded that Rituxan® is a viable treatment option for patients with relapsed Hodgkin’s lymphoma that expresses the CD 20 antigen clinical trials.
In summary, there are two Phase II trials that demonstrate some effectiveness in a specific subset of Hodgkin’s Lymphoma – Lymphocyte Predominant. NCCN also recommends Rituxan on p. HODG-E of Hodgkin’s guidelines.
The 2012 NCCN added a footnote to the lymphocyte-predominant Hodgkin lymphoma (LPHL) primary treatment recommendations, “In some patients treated with rituximab alone, maintenance rituximab may be considered for 2 years.”
Michelle Fanale, Lymphocyte-predominant Hodgkin lymphoma: what is the
optimal treatment? ASH, 2013 – http://asheducationbook.hematologylibrary.org/content/2013/1/406.full.pdf
http://www.nccn.org/about/news/ebulletin/ebulletindetail.aspx?ebulletinid=154m NCCN 2012
D. Re, R. K. Thomas, K. Behringer, and V. Diehl
From Hodgkin disease to Hodgkin lymphoma: biologic insights and therapeutic potential
Blood, June 15, 2005; 105(12): 4553 – 4560.
Yasuhiro Oki MD, Barbara Pro MD et al, study of gemcitabine in combination with rituximab in patients with recurrent or refractory Hodgkin lymphoma
Cancer Volume 112, Issue 4, pages 831–836, 15 February 2008
Oki Y, Younes A. Does rituximab have a place in treating classic hodgkin lymphoma?Curr Hematol Malig Rep. 2010 Jul;5(3):135-9