New drug for non-Hodgkin’s lymphoma shows promise

By Dr. Ananya Mandal, MDDec 5 2010

Genentech Inc., now part of Swiss drug developer Roche, and Biogen Idec Inc. on Sunday have announced positive and encouraging results from a clinical study of cancer drug Rituxan in patients with advanced type of non-Hodgkin’s lymphoma. An estimated 65,540 people in the US were diagnosed with non-Hodgkin's lymphoma this year, and follicular lymphoma accounts for about 15 to 20 percent of those cases. The disease can occur at any time during adulthood, though people are typically diagnosed during their 50s and 60s.

The trial involved patients with follicular lymphoma, a cancer of the blood. None of the patients in the study were yet to show symptoms of the disease. The researchers began therapy with Rituxan before symptoms worsened followed by continued use of the drug and noted delayed the need for chemotherapy or radiotherapy and decreased the risk of the disease worsening, compared to standard “watchful waiting” approach. Among those who followed the traditional watch-and-wait approach, the average time to initiation of new therapy such as chemotherapy or radiotherapy was 34 months whereas the average profession-free survival was 23 months. In contrast, among those who received Rituxan, the time for the need of additional therapy was reduced by 80 percent and the risk of disease progression was decreased by 79 percent.  The progression free survival was extended to up to 4 years. Earlier studies failed to show any meaningful benefits of early treatment.

This was a phase II trial with Rituxan or Rituximab. Rituxan, first approved in 1997, is currently marketed for treating non-Hodgkin’s lymphoma, rheumatoid arthritis and chronic lymphocytic leukemia or CLL. The drug, given by infusion, is an antibody that binds to a specific protein, CD20, found on the surface of malignant and normal B-cell lymphocytes, employing the body’s own immune system soldiers to kill marked cancer cells.

The findings were presented on Sunday at the 52nd Annual Meeting of the American Society of Hematology in Orlando, Florida. The data was presented by Kirit Ardeshna, one of the researchers.

On the flip side Rituxan carries the risk of some serious side effects including infection, which affected 4 percent of patients, allergy affecting 3 percent, neutropenia or very low neutrophil count affecting 3 percent and neutropenic sepsis 1 percent.

Lymphoma prevention

In another study researchers have found that nitrite intake could increase risk of follicular lymphoma. The study appeared in June 2010 issue of Cancer Causes & Control and showed that those whose intake was in the highest quartile were 40 percent more likely to be diagnosed with follicular lymphoma, compared with those whose intake was in the lowest quartile. Lead researcher B. A. Klifoy and team of National Institutes of Health found the association after they studied data from 1,304 women in Connecticut.

In yet another study led by E. Erber and colleagues from University of Hawaii published in the Aug 2009 issue of Leukemia & Lymphoma it was shown that high vegetable dietary pattern may reduce the risk of follicular lymphoma by up to 44 percent whereas the fat and meat dietary pattern boosted the risk by 5 times. The team had involved data from the Multiethnic Cohort including more than 215,000 Caucasians, African-Americans, Japanese-Americans, Native Hawaiians, and Latinos aged 45-75 at baseline.

Similar conclusions were drawn in another study which showed that higher intake of total fruits and vegetables may cut the risk of follicular lymphoma by 31 percent.  Especially yellow/orange, cruciferous vegetables, broccoli, and apple juice/cider were associated with lower risk of non-Hodgkin’s lymphoma. This study was led by C. A.Thompson and colleagues from College of Medicine Mayo Clinic in Rochester, MN and published in the Feb 15, 20010 issue of International Journal of Cancer.