Combining Three Cell-Killing Effects Offers Best Chance For Cure

June 27, 2008

DURHAM, N.C. -- Optimized biological treatment -- combining advanced antibody therapy plus chemotherapy -- offers a promising approach to the treatment of a cancer called 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 new article by Dr. Franz Buchegger, Dr. Oliver Press, and colleagues from the Fred Hutchinson Cancer Research Center, Seattle, and University Hospital of Lausanne, Switzerland.

Follicular lymphoma is a type of non-Hodgkin's lymphoma (NHL) in which tumors arise in lymph nodes. When follicular lymphoma reaches an advanced stage, it can be treated with various types of chemotherapy. However, on its own, chemotherapy does not enhance survival.

In recent years, two new types of immunotherapy for follicular lymphoma and other types of NHL have been introduced. One is a "biological" therapy called rituximab (brand name Rituxan) -- an antibody that works by attacking certain types of immune cells (B cells) involved in lymphoma. The other is an approach called radioimmunotherapy (RIT), in which antibodies labeled with radioactive isotopes are used to target and destroy lymphoma cells. Two different RIT products are FDA approved: Bexxar and Zevalin.

In their article, the authors suggest that combining all three approaches -- chemotherapy, rituximab, and RIT -- could provide an effective new treatment option for patients with advanced follicular lymphoma. In theory, this 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.

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. Other approaches-for example, 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. Dr. Buchegger and Dr. Press and coauthors state, "[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 by Drs. John P. Plastaras, Eli Glatstein, and Stephen J. Schuster of the Hospital of the University of Pennsylvania seconds the call for further study of antibody-based therapies for follicular lymphoma. They cite 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. Urging physicians to overcome their unfamiliarity with these antibody-based therapies, the authors conclude, "The available information suggests that it is about time to let the tail was the dog!"

The article, entitled "Radiolabeled and native antibodies and the prospect of cure of follicular lymphoma," and the accompanying commentary, entitled "Let the tail wag the dog: The case for radioimmunotherapy of low-grade follicular lymphoma," are published in the June issue of "The Oncologist" and are freely available online at: http://theoncologist.alphamedpress.org/cgi/content/full/13/6/657 and http://theoncologist.alphamedpress.org/cgi/content/full/13/6/655, respectively.

About AlphaMed Press

AlphaMed Press publishes the internationally renowned journals, "Stem Cells" and "The Oncologist." "Stem Cells," now in its 26th year, is the oldest and one of the world's top-tier peer-reviewed monthly journals in the fast-paced area of stem cells and regenerative medicine. "The Oncologist," in its 13th year, is a premier peer-reviewed monthly journal dedicated to physicians entrusted with the care of cancer patients.

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