Study Adds to Evidence That Rituximab Slows Lymphoma Symptoms
Whether benefits outweigh cost of treatment sparks debate
TUESDAY, Dec. 21, 2010 (HealthDay News) -- New research provides more evidence that treating certain lymphoma patients with an expensive drug over the long term helps them go longer without symptoms. But the drug, called rituximab (Rituxan), does not seem to significantly increase life span, raising questions about whether it's worth taking.
People with lymphoma who are considering maintenance treatment "really need a discussion with [their] oncologist," said Dr. Steven T. Rosen, director of the Robert H. Lurie Comprehensive Cancer Center at Northwestern University in Chicago.
The study involved people with follicular lymphoma, one of the milder forms of non-Hodgkin lymphoma, a term that refers to cancers of the immune system. Though it can be fatal, most people live for at least 10 years after diagnosis.
There has been debate over whether people with the disease should take Rituxan as maintenance therapy after their initial chemotherapy. In the study, which was funded in part by F. Hoffmann-La Roche, a pharmaceutical company that sells Rituxan, roughly half of the 1,019 participants took Rituxan, and the others did not. All previously had taken the drug right after receiving chemotherapy.
In the next three years, the study found, people taking the drug took longer, on average, to develop symptoms. Three-quarters of them made it to the three-year mark without progression of their illness, compared with about 58 percent of those who didn't take the drug. But the death rate over three years remained about the same, according to the report, published online Dec. 21 in The Lancet.
The drug "should now be considered as first-line treatment for these patients," wrote Dr. Gilles Salles of Hospices Civils de Lyon & Universite Claude Bernard in Lyon, France, and his research colleagues.
But Rosen said there's still a divide over use of the drug as maintenance therapy. "Physicians are falling into two groups," he said. "One says, 'There was no survival advantage, I'd just wait until you have progression and then re-treat you. That's not unreasonable.'"
Another group "would say that there's potentially better quality of life during the period without disease," Rosen said. "But the psychological benefits from not having any evidence of disease are hard to measure."
In a comment accompanying the report in The Lancet, Dr. Jonathan Friedberg, of the hematology and oncology division at the University of Rochester in Rochester, N.Y., wrote that "an analysis of cost-effectiveness would be very helpful."
"In an era of increased health-care costs, what benefit is necessary to justify the cost of this maintenance strategy, which at my institution would cost Medicare more than $60,000 per patient?" Friedberg asked.
He also described as premature the researchers' statement that maintenance therapy with the drug should be prescribed for all people with follicular lymphoma who are initially treated with rituximab plus chemotherapy.
"However, maintenance is an option," Friedberg said, adding that "the investigators are to be congratulated for this important contribution and are strongly encouraged to continue follow-up of these patients to answer the questions that remain."
The U.S. National Cancer Institute has more on lymphoma.