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Lymphoma

Attacking NHL Early

Summary & Participants

Targeted therapies are not just for advanced cases non Hodgkin's lymphoma. Learn how they can help against indolent or low-grade cancers as well.

Medically Reviewed On: July 11, 2008

Webcast Transcript

ANNOUNCER: About 40 percent of cases of non-Hodgkin's lymphoma are non-aggressive, or "indolent," forms of the disease. While indolent lymphoma, at onset, is of less immediate danger to a patient than more aggressive forms, it generally is not curable.

JOHN LEONARD, MD: I think, in indolent lymphoma, ideally, we would like to get rid of the disease, to cure the disease. In indolent lymphomas, that's a very difficult thing to do. People can live with the disease for many, many years, and I think a realistic goal is to try to make it a chronic disease, where you manage the disease in a long term fashion, where patients can live a relatively normal life over that time.

ANNOUNCER: Sometimes doctors and patients defer treatment, opting instead to monitor the disease carefully. When treatment does become necessary, the traditional course has been chemotherapy. Beginning in the late 1990s, doctors began adding another type of drug, what's called an anti-CD20 monoclonal antibody. For indolent lymphomas, the drug, called rituximab, has been approved for recurrent or resistant disease. But research shows it can also be useful earlier on.

SANDRA J. HORNING, MD: In indolent lymphoma, the combination of the rituximab anti-CD20 monoclonal antibody with chemotherapy has consistently, in several studies, demonstrated a higher rate of overall response, improved the quality of response, and lengthened the time to disease progression.

ANNOUNCER: Lengthening the time to progression, however, does not automatically mean a patient will live longer. Doctors say there are hints from clinical trial data that rituximab could, in some cases, increase survival. But it's really too soon to tell.

JOHN LEONARD, MD: I think the main question is the long term outcomes, and for many people the ultimate goal is to be alive and do well in the long term, decades down the line. And it's still too early in the game, so to speak, to know what does rituximab do in the long term, ten, twenty years down the line. We're encouraged about these short term benefits and hope that they translate into longer term benefits, but we need to follow this issue further in studies that are going on now.

ANNOUNCER: Monoclonal antibodies have few side effects, except flu-like symptoms while it is being administered. As a result, some doctors try using it alone, as monotherapy, especially in cases where "watchful waiting" might be the alternative.

SANDRA J. HORNING, MD: I think the prospects of having a treatment that's effective and relatively nontoxic-that is, relative to chemotherapy-can change the way that patients and their physicians look at the policy of watchful waiting. And under these circumstances, it may be appropriate in some cases to use rituximab as a single agent as initial therapy. Again, this is something that is being studied in the context of clinical trials, both in the United States and in Europe.

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