Sunday, March 08, 2009

March 8, 2009 - The Treatment I Didn't Get

Today I run across a Reuters news article about rituximab (trade name, Rituxan), the monoclonal antibody drug I received along with my chemotherapy. It seems a research study has just demonstrated good results for “maintenance therapy” with Rituxan – in other words, continuing treatment with the drug over time, even after the cancer has gone into remission:

“An improved disease response was seen in 22% of rituximab-treated patients versus just 7% of control subjects....

Three-year progression-free survival was also higher in the rituximab group: 68% vs. 33% in controls. In the subgroup of 282 patients with follicular lymphoma, the corresponding rates were 64% and 33%. Higher overall survival rates were seen in the rituximab group as well, although the differences fell short of statistical significance....

‘Observations from this study inform the design of future studies and add to a substantial body of evidence that the combination of rituximab with chemotherapy is a new standard for patients with indolent lymphoma who require treatment,’ the authors conclude.”

At the time my R-CHOP chemotherapy ended (the “R” in R-CHOP stands for Rituxan), I was aware that some patients were continuing to receive monthly treatments with Rituxan for a year or more, as a preventative measure. This was, and continues to be, somewhat controversial. At several NHL patients’ conferences I attended, the medical experts making the speeches said the jury was still out on whether or not maintenance Rituxan does any good. With the tremendously high cost of this medication, many medical insurers had labeled it “experimental,” and were not funding its use in maintenance treatment. (I never took the matter up with my insurance people, because Dr. Lerner didn’t recommend maintenance Rituxan in my case.)

Well, now the jury has filed back into the courtroom and delivered their verdict: maintenance Rituxan does work – at least for indolent NHL patients who have had the CVP chemo regimen (cyclophosphamide, vincristine and prednisone). The researchers didn’t focus on patients who’ve had the CHOP chemo cocktail, rather than CVP – although, since vincristine and prednisone are two out of the four drugs in CHOP, I would think there’s a pretty good chance maintenance Rituxan would have improved my long-term prognosis, as well.

This raises a lot of unanswered – and probably unanswerable – questions for me. Chief among them is, if I had received maintenance Rituxan, would my remission have lasted longer than it did?

Hindsight, as they say, is 20/20. I’m not going to run off and ask Dr. Lerner about maintenance Rituxan now, but it does give me something to think about. Maybe I'll ask him what he thinks of this article, next time I see him...


Anonymous said...

I was given Fludarabine, Cytoxan and Rituxan for my indolent follicular NHL and my oncologist really wanted me to do the maintenance Rituxan. My second oncologist said I did not need it as I had had a complete response to treatment in a very short space of time. So I was reluctant, mostly because I was tired of treatment and there are some risks involved, such as even more suppression of immune system. I have not relapsed as yet but, when I do, I will agree to at least ask my medical insurance for cover to do the Rituxan maintenance.


MaureenL said...

My husband was diagnosed with NHL (B-cell follicular indolent) last July 2nd. He received 6 cycles of Fludarabine, Cytoxan, and Rituxan. He's been in remission since December. He's scheduled to begin Rituxan maintenance on June 5th and then get it every 3-4 months for 2 years. As long as our insurance will pay for it (I guess I'd better check to make sure), we've decided to go for it. Because his NHL is not considered to be curable, we want to proactively keep it at bay.

Carl said...

Alison and Maureen,

Your respective stories illustrate how volatile the whole field of NHL treatment is right now - which is a good thing, because it means new medicines are on the verge of being released. It also means, though, that today's rock-solid treatment protocol can quickly change into yesterday's historical artifact.

The ground's moving under our feet, as patients - which can be a little disorienting.

It certainly does sound like maintenance Rituxan is getting better and better press, as more of these research studies are conducted.

Grace and peace.