New Approaches to Treating Non-Hodgkin’s Lymphoma

NEW YORK—Although a cure for non-Hodgkin’s lymphoma remains elusive, several potential new approaches could bolster remissions, Richard I. Fisher, MD, told patients during a Cancer Care, Inc. teleconference.

Dr. Fisher is chairman of the Southwest Oncology Group (SWOG) and director of the Cardinal Bernardine Cancer Center, Loyola University Medical Center, Maywood, Illinois.

“The more options we have, the longer we can prolong the remissions. Patients have good quality of life for that time without medication or treatment toxicity or symptoms from the disease,” Dr. Fisher said.

Purine analogs such as fludarabine (Fludara) or cladribine (Leustatin) have already been shown to work well in chronic lymphocytic leukemia (CLL) and in follicular lymphoma, but it is not known, Dr. Fisher said, how well they might work in patients who have not been treated before. “That is the problem with many of the new agents. They have been used first in previously treated patients. We are trying to figure out if they actually might work better if used earlier in the course of the disease.”

SWOG’s Lymphoma Committee has been conducting a study of fludarabine and mitoxantrone (Novantrone) in more than 100 previously untreated lymphoma patients. The regimen was very well tolerated, and a large number of patients went into remission, Dr. Fisher said, but further follow-up is needed. “One of the good things about the regimen is that it does not cause hair loss,” he added.

Rituximab Therapy

SWOG and other groups are also testing the ability of the recently approved anti-CD20 monoclonal antibody rituximab (Rituxan) to “mop up” residual disease in lymphoma patients previously treated with chemotherapy. The monoclonal antibody has been shown to produce responses in about half of patients who had previous rounds of treatment, Dr. Fisher said.

“The nice thing about Rituxan is that it has been relatively nontoxic,” he said. “It’s a short treatment course. Some patients have fever and chills with the infusions, but long-term toxicities have not been high, and there have been some good partial responses.” Radiolabeled antibodies are also under investigation, he said.

Future of Transplantation

As for the future of transplantation, only long-term follow-up can determine its ultimate value, he said, but it is definitely much safer than before.

“It used to be a high-risk procedure with a good deal of early mortality. Patients had to spend 4 weeks in a hospital in isolation,” Dr. Fisher said. “Now, in our hospital, we do high-dose therapy as an outpatient procedure, and patients simply stay for 2 weeks in the area. So there really has been tremendous improvement in quality of life for patients getting transplantation. We know it’s a very good form of treatment. But we can’t yet say that it cures patients because we don’t have long enough follow-up.”

Dr. Fisher stressed that it is important to explore the potential of many modalities. “Having done this for over 25 years, I have learned that you don’t want to put all your eggs in one basket. You want to follow all the leads that look promising, that are rational. You can guess how things are going to turn out, but quite frankly, those guesses are not always the result that is seen in clinical trials. So a broad-based rational program is the most likely way to get advances.”