Rituximab and chemotherapy is highly effective in patients with CD20-positive non-Hodgkin’s lymphoma and HIV
Sean Hosein, CATIE News
In high-income countries, the availability of highly active antiretroviral therapy (HAART) has led to dramatic decreases in deaths from many AIDS-related complications. This is true particularly of infections. Yet decreases in AIDS-related cancers, such as non-Hodgkin’s lymphoma (NHL), have not been as dramatic in the few years since HAART has been available.
To enhance the effectiveness of anti-cancer therapy for people with HIV/AIDS (PHAs), researchers have been testing a novel therapy called Rituxan (Mabthera, rituximab). This therapy consists of antibodies that attack tumours. Researchers in Italy are reporting increased survival in PHAs with certain cancers who receive Rituxan as part of their anti-cancer therapy.
The research team reported results on 38 HIV positive subjects who were recruited between June 1998 and October 2001. The profile of these people was as follows:
- 15% female, 85% male
- average CD4+ count – 120 cells
- Most were diagnosed with either NHL or another cancer called Burkitt’s lymphoma
- About half the subjects had symptoms such as fever, night sweats, swollen lymph nodes and unintentional weight loss
Researchers gave subjects standard chemotherapy taken intravenously for “four days every four weeks”; this was called a cycle. Rituxan was given intravenously at a dose of 375 mg per square metre of skin surface, one day before each cycle. Subjects were expected to take at least six cycles of chemotherapy. Bone marrow stimulants and various antibiotics/anti-fungal drugs were also prescribed to reduce the risk of infections that can develop during chemotherapy. In addition, all subjects took HAART.
Here’s what happened to the 38 subjects:
- 76% – their tumours disappeared
- 5% – their tumours shrunk but did not go away
- 19% – their tumours continued to grow
Two years after receiving this therapy, the researchers calculated that about 70% of their subjects were still alive, with only 10% of those who were initially cured experiencing a relapse. Most deaths were due to complications from NHL. Encouraged by these results, the researchers are considering a larger clinical trial to confirm their findings.
Rituxan belongs to a group of drugs called monoclonal antibodies. It works by locking onto tumours that have a protein called CD20, which is found on certain cancer cells. The antibody helps the immune system destroy the tumour. All subjects in this study had cancer cells that had CD20. Rituxan is licensed for use in North America and the countries of the European Union.
- Spina M, Sparano JA, Jaeger U, et al. Rituximab and chemotherapy is highly effective in patients with CD20-positive non-Hodgkin’s lymphoma and HIV infection. AIDS 2003 Jan 3;17(1):137-8.
- Manches O, Lui G, Chapero L, et al. In vitro mechanisms of action of rituximab on primary non-Hodgkin lymphomas. Blood 2003 Feb 1;101(3):949-54.
The Italian study used a background chemotherapy of infusional cyclophosphamide, doxorubicin and etoposide and was presented as a poster at the Retrovirus conference. A second study from the French ANRS group reported using rituximab with CHOP chemotherapy in HIV patients with high-grade lymphoma (Abstracts 803 and 804 respectively).
Source: CATIE News
Copyright 2003 – CATIE TreatmentUpdate. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Editor, The Community AIDS Treatment Information Exchange, Suite 420 – 517 College Street, Toronto, On M6G 4A2 Canada http://www.catie.ca