Rituxan Maintenance?

Rituxan Maintenance is a very big issue in the Follicular NHL world these days. It's the practice of giving post-chemo patients one or more courses of Rituxan, as a way of cleaning up any residual cancer cells, months after the initial chemo. The time span, and the number of rounds per course, vary depending on the doctor and patient. There's some good evidence to go with either side of this issue -- give the R maintenance, or treat only as needed -- which is why it's still so controversial.

The most recent bit of evidence showed that R maintenance does not increase Overall Survival in fNHL patients. (This came from a presentation at this year's ASH conference.) When I was finished with my own (first-line) Rituxan treatment, I asked Dr. R what he thought of maintenance. After our discussion, I decided not to pursue it; he convinced me that the evidence did not suggest that it would be worth the time and expense. Of course, this was post-Rituxan, not post-chemo, and there is much less evidence either way for my situation.

And while I am pleased with my own choice (it's been over 2 years since my last round of Rituxan ), the larger question remains of whether or not R maintenance is still a viable option for most fNHL patients.

The upcoming issue of Oncology Times features a Point/Counterpoint on this controversy, a summary of a live debate between two Lymphoma Rock Stars: Dr. David Mahoney from Fred Hutchinson in Seattle, who took the pro-maintenance side, and Dr. Bruce Cheson of Georgetown, who took the anti-maintenance side. [Full disclosure: if cancer researchers had their own baseball cards, and I opened a pack to find that I got a Bruce Cheson, I'd pee my pants with delight. And, yeah, it's weird enough to have a favorite lymphoma researcher, let alone be that excited about it, but that's what happens when you blog three or four times a week about cancer. I'm at peace with it.]

A live audience listened to the two Rock Stars make their cases, and then voted on who was more persuasive. Much to my chagrin, Maloney's pro-maintenance argument won out. (But I still love you, Bruce Cheson.)

But there was some interesting information in the debate anyway, that i hadn't heard before, including the moderator's statement that he sees a rise in infections from patients on maintenance, including sinus infections that can't be cured with antibiotics, and require a more expensive treatment.

So the pro-maintenance folks seem to have won this round, but it's pretty clear that, like much having to do with Follicular NHL, there are no easy answers.

Still, I think healthy debate is a very good thing. More information, more provoking of thought, for doctors and for patients, can only help us all.