Rituxan for paraneoplastic syndromes – pro
Paraneoplastic syndromes are remote effects of cancer, usually by hormone like substances secreted by a cancer. They can range for very common, such as cancer induced fatigue or cachexia, to uncommon neurological syndromes. Since Rituxan is a modifier of the immune system, it can potentially interrupt paraneoplastic syndroems with an auto-immune component. Recent reports in the literature suggest that antibody associated autoimmune disorders may respond to rituximab.
Paraneoplastic syndromes are rare and diverse, prospective studies are difficult to do. A recent review ( Greenley) says, “Cyclophosphamide or rituximab may be helpful in patients who fail to stabilize or improve on less aggressive therapies.” Thus, medical literature does not support front line use of Rituxan.
Shams’ili S, de Beukelaar J, Gratama JW, Hooijkaas H, van den Bent M, van ‘t Veer M, Sillevis Smitt P, An uncontrolled trial of rituximab for antibody associated paraneoplastic neurological syndromes.J Neurol. 2006 Jan;253(1):16-20.
Orange D, Frank M, Tian S, Dousmanis A, Marmur R, Buckley N, Parveen S, Graber JJ, Blachre N, Darnell RB. Cellular immune suppression in paraneoplastic neurologic syndromes targeting intracellular antigens.Arch Neurol. 2012 Sep;69(9):1132-40
Greenlee JE. Treatment of paraneoplastic neurologic disorders. Curr Treat Options Neurol. 2010 May;12(3):212-30