Combined therapy offers hope to patients with follicular lymphoma

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Optimized biological treatment, or combining advanced antibody therapy with chemotherapy, offers a promising approach to the treatment of follicular lymphoma, according to a report in the June issue of The Oncologist.

"The triple-therapy approach employing upfront chemotherapy combined with an optimized radioimmunotherapy and extended biologic treatment with antibodies may represent the best chance for prolonged disease-free survival and potential cure of patients with follicular lymphoma,” according to the article by Franz Buchegger, MD, Oliver Press, MD, and colleagues from the Fred Hutchinson Cancer Research Center in Seattle, and University Hospital of Lausanne in Switzerland.

Follicular lymphoma is a type of non-Hodgkin's lymphoma (NHL), which usually can be treated with various types of chemotherapy. However, chemotherapy on its own does not enhance survival, according to the researchers.

Two new types of immunotherapy for follicular lymphoma and other types of NHL have been introduced. One is a biological therapy called rituximab (Rituxan) -- an antibody that works by attacking certain types of immune cells (B cells) involved in lymphoma. The other is radioimmunotherapy (RIT). Two different RIT products are FDA approved: Bexxar and Zevalin.

According to the article, the authors suggested that combining all three approaches—chemotherapy, rituximab and RIT—could provide an effective new treatment option for patients with advanced follicular lymphoma. The approach would combine the advantages of all three treatments, each of which kills cancer cells in different ways: chemotherapy by direct toxic effects, rituximab through immunologic activity and RIT by radiation, Buchegger, Press and colleagues said.

The three-pronged strategy is especially promising because previous research has shown that both antibody-based therapies seem to add to the cancer-killing effects of chemotherapy, the authors noted. Other approaches such as treatments targeting immune-active substances called cytokines are also being investigated in combination with rituximab and RIT.

Until recently, RIT has been recommended only for follicular lymphomas that fail to respond to other treatments. Starting treatment including RIT at an earlier stage of the disease might improve its effectiveness. Buchegger, Press and coauthors stated that, "[O]ptimized biological treatment combined with radiolabeled antibodies and chemotherapy will afford the greatest potential for durable complete responses and possibly for cure of a currently incurable disease by conventional methods."

An accompanying commentary supported the call for further study of antibody-based therapies for follicular lymphoma. The authors of the commentary cited recent studies of RIT, in which the "tail" of the survival curve indicates that long-term survival without progressive cancer is possible for many patients. The authors urge physicians to overcome their unfamiliarity with these antibody-based therapies.