-- Randy Dotinga
TUESDAY, Dec. 21 (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
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 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
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
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
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