JOHN HAINSWORTH, MD: The median survival of patients with low-grade lymphomas is about eight years. So a lot of patients do well, but they're never free of the lymphoma.
ANNOUNCER: Never being free of low-grade, or indolent, lymphoma means the disease is likely to recur, requiring additional rounds of treatment.
JOHN LEONARD, MD: Standard options for patients who have relapsed indolent lymphoma include many of the same chemotherapy regimens that we use as initial treatment. The challenge is that they tend to be less effective the second, third, fourth time around than they are the first time around.
ANNOUNCER: In 1997, a different type of drug, called a monoclonal antibody, was approved as an alternative treatment for recurrent, indolent lymphoma.
SANDRA J. HORNING, MD: There was a lot of enthusiasm about the advent of a treatment that was effective and was safe. The major difference with rituximab compared to conventional chemotherapy is twofold. One, it's a different form of therapy. It attacks cells in a different way, so that patients who were no longer responsive to chemotherapy could still respond to rituximab. And perhaps even more importantly, it had very little toxicity, so the treatment could be a respite for patients with recurrent disease, from the toxicities associated with treatment, particularly with chemotherapy.
ANNOUNCER: The initial studies, on older patients with NHL, showed similar results as for patients treated with a second round of chemotherapy.
JOHN LEONARD, MD: Those results showed that about 50 to 60 percent of patients with relapsed indolent lymphoma had response or tumor shrinkage of their disease to a treatment of four doses of rituximab. And, in general, those responses lasted in the range of about a year.
SANDRA J. HORNING, MD: I would say the relapse rate with rituximab is roughly equal to that seen with combination chemotherapy, but it's important to know that the likelihood of response and the duration of response is highly variable and depends upon individual patient characteristics and their history.
ANNOUNCER: The use of monoclonal antibodies against recurrent, indolent disease can be alone or in combination with chemotherapy. The choice often depends on how quickly a patient might need a response.
SANDRA J. HORNING, MD: What we have learned over the years in treating indolent lymphoma is that combination therapy is particularly indicated or effective in the situation where a patient has a recurrence that is in the category of a large amount of disease and/or disease that is growing quickly or causing symptoms. In a setting where a patient has an asymptomatic low tumor volume recurrence, that's a setting where historically we have perhaps observed patients, but in our current management have rituximab as a single agent to offer as an alternative.
ANNOUNCER: Several treatment options are available for patients with recurrent, indolent non-Hodgkin's lymphoma. But since treating recurrent disease is often more difficult than initial treatment, doctors welcome each new option.
JOHN LEONARD, MD: In some scenarios, patients are not responding to a specific form of treatment such as chemotherapy, so having a different type of treatment such as an antibody-based treatment can be helpful and provide them with another option. And vice-versa, some patients have disease that's not responding to an antibody such as rituximab, and chemotherapy may be a useful option. So I think the more drugs we have that are effective, the more options we have for patients to be able to use when other things aren't working as well.