Oxaliplatin and Rituxan for Hodgkin’s – pro

Rituxan is a promising drug for Hodgkin’s but more studies need to be done. Oxaliplatin is currrently in a clinical trial: Oxaliplatin in Treating Patients With Relapsed or Refractory Non-Hodgkin’s Lymphoma., NCT00006473, completed but not published yet. It is a Phase II trial to study the effectiveness of oxaliplatin in treating patients who have relapsed or refractory non-Hodgkin’s lymphoma.

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. 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.

Combination of the two was recenlty tried in 8 elderly relapsed/ reefractory patients. One complete response, 3 partial response and 3 minimal response were obtained at 11 months of median time follow-up.

The combination of these two drugs with gemcitabine has recently been reported as well in a single phase II study. Rituximab, gemcitabine and oxaliplatin are active as single agents in relapsed or refractory lymphoma, and have demonstrated synergistic effects in vitro and in vivo.

In summary, there are two Phase II trials that demonstrate some effectiveness of Rituxan in a specific subset of Hodgkin’s Lymphoma. First, it needs to be determined if the patient has lymphocyte predominant disease. Most plans will consider this therapy to be investigational but where coverage is availble it is certainly an interesting and promising option.

Rehwald U, Schultz H, Reiser M, et al. Treatment of relapsed CD20+ Hodgkin lymphoma with monoclonal antibody rituximab is effective and well tolerated: results of a phase 2 trial of the German Hodgkin Lymphoma Study Group. Blood. 2003;101:420-424.

Rehwald U, Schulz H, Reiser M, et al. German Hodgkin Lymphoma Study Group (GHSG): treatment of relapsed CD20+ Hodgkin lymphoma with the monoclonal antibody rituximab is effective and well tolerated: results of a phase 2 trial of the German Hodgkin Lymphoma Study Group. Blood. 2003;101: 420-424.

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.

Addeo R, Caraglia M, Costanzo R, Faiola V, Montella L, Abbruzzese A, Del Prete S. Oxaliplatin/rituximab combination in the treatment of intermediate-low grade non-Hodgkin’s lymphoma of elderly patients. Oncol Rep. 2004 Jul;12(1):135-40

T El Gnaoui , J Dupuis , K Belhadj , J-P Jais , A Rahmouni , C Copie-Bergman , I Gaillard , M Diviné , I Tabah-Fisch , F Reyes , and C Haioun Rituximab, gemcitabine and oxaliplatin: an effective salvage regimen for patients with relapsed or refractory B-cell lymphoma not candidates for high-dose therapy
Annals of Oncology Advance Access published on August 1, 2007, DOI 10.1093/annonc/mdm133.
Ann Oncol 18: 1363-1368.

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