Cancer Treatment Today

The CHOP combination CT, administered every 21 days, is the standard for the treatment of advanced DLBCL for many years, with long-term disease-free survival in approximately 35% of patients. One of the newer developments is the addition of rituximab, a humanized anti-CD20 monoclonal antibody. The role of rituximab was first evaluated in elderly (>65 years) patients with DLBCL and the addition of rituximab to conventional CHOP (administered every 21 days, at standard doses) leads to a significant improvement in outcome. Eight cycles of rituximab-CHOP (R-CHOP) produced a complete response in 75% of patients versus 63% of CHOP alone (p = 0.005), with a significant 5-year survival benefit in terms of event-free (47 vs 29%), progression-free (54 vs 30%) and overall survival (58 vs 45%). The addition of rituximab did not substantially increase the toxicity of CHOP, even though a trend towards an increased risk of infections was observed after R-CHOP compared with CHOP. A cooperative American study in elderly patients comparing up-front CHOP with or without rituximab and with or without rituximab maintenance confirmed the GELA results, with a significant advantage for patients receiving rituximab, either as part of induction or maintenance therapy.

Rituxan® (rituximab) is FDA indicated for the treatment of patients with:

• Relapsed or refractory, low-grade or follicular, CD20-positive, B-cell NHL as a single agent
• Previously untreated follicular, CD20-positive, B-cell NHL in combination with CVP chemotherapy
• Non-progressing (including stable disease), low-grade, CD20-positive, B-cell NHL, as a single agent, after first-line CVP chemotherapy
• Previously untreated diffuse large B-cell, CD20-positive NHL in combination with CHOP or other anthracycline-based chemotherapy regimens

Milliman Care Guidelines® Ambulatory Care, 14th Edition, Rituximab
ACG: A-0448 (AC) says:
Rituximab is a recombinant monoclonal antibody that targets CD20, a protein expressed on the surface of B lymphocytes, causing cell death. For B-cell non-Hodgkin lymphomas, several literature and systematic reviews that included numerous randomized controlled trials found rituximab to be effective in improving progression-free and overall survival for several types of this disease in adults and children.

1. Coiffier B, Lepage E, Brière J et al.: CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N. Engl. J. Med. 346, 235-242 (2002).
   Feugier P, van Hoof A, Sebban C et al.: Long-term results of the R-CHOP study in the treatment of elderly patients with diffuse large B-cell lymphoma: A study by the Groupe d’Etude des Lymphomes de l’Adulte. J. Clin. Oncol. 23, 4117-4126 (2005).
2. Habermann TM, Weller EA, Morrison VA et al.: Rituximab-CHOP versus CHOP alone or with maintenance rituximab in older patients with diffuse large B-cell lymphoma. J. Clin. Oncol. 24, 3121-3127 (2006).