Bendamustine for Follicular Lymphoma

This month's Medical Oncology journal offers a review article on Bendamustine (aka Treanda) as a possible first-line treatment for Non-Hodgkin's Lymphoma. To be clear: it isn't offering any new research about Bendamustine. Instead, it discusses some of the recent research to argue that it might be time to consider Bendamustine as first choice.

Right now, in the U.S., the FDA has approved Bendamustine as a second-line treatment for indolent lynphomas (including Follicular Lymphoma), used within six months of treatment with Rituxan (or a combination involving Rituxan) if the disease has progressed. It gets used in ways other than that, but the authors of this article think we should make that official.

(If the link above doesn't take you to the article, try this one, the journal's home page, and scroll down to the link "Bendamustine-based therapy as first-line treatment for non-Hodgkin lymphoma.")

 The article looks at studies of Bendamustine as it is used for patients with indolent lymphomas (including Follicular Lymphoma), Mantle Cell Lymphoma, and aggressive lymphomas (including DLBCL). The indolent lymphomas are the ones that matter most to me (and probably you, if you're reading this).

The section on indolent lymphomas looks at a bunch of published studies, as well as some recent conference presentations. The biggies are there, including studies that compared Bendamustine and Rituxan with CHOP, and again with CHOP and CVP. Bendamustine, of course, came out on top of these studies, with greater effectiveness and, just as importantly, less toxicity.

The low toxicity (and few side effects) of Bendamustine are big part of the authors' argument. The reasons for its low toxicity are still not fully understood, and the authors recommend more long-term study of side effects, but for the most part, Bendamustine is safer than other options. It is more cost-effective than COP or CVP, in part because there is less need to deal with side effects.

So, again, this article doesn't present anything new. But it does suggest that it's time to consider Bendamustine as an approved first-line treatment. It's certainly used that way now, but it would be nice to make it all official.