No Chemotherapy Required?

Rituxan instead of chemotherapy?

The Journal of Clinical Oncology published the results of long-term trials from the Nordic Lymphoma Group. They showed that, over 10 years, a group of Follicular Lymphoma patients had excellent Overall Survival, even without chemotherapy.

If you've been following the blog, you know that this means a lot to me, because I'm one of those FL patients who has had great results over a long time (over 8 years) with just Rituxan.

The article is called "Chemotherapy-Free Initial Treatment of Advanced Indolent Lymphoma Has Durable Effect With Low Toxicity: Results From Two Nordic Lymphoma Group Trials With More Than 10 Years of Follow-Up."

The study looked at 321 patients with indolent lymphoma (84% of them had Follicular Lymphoma). The patients were symptomatic and had a high tumor burden. All of them received one or two cycles of four weekly infusions of Rituxan. About half of them also received Interferon (another biological agent -- not a chemotherapy -- that is more common in Europe than the U.S., from what I can tell).

Patients were followed for a median of 10.6 years. At the 10 year follow up, 73% of patients were alive. 36% of them (38% of FL patients) never needed chemotherapy. For patients who needed treatment within 24 months, the 10 year survival rate was 59% (81% for patients who didn't need treatment that soon).

Those 10 year numbers are important, because they are about the same as studies of patients who have immunochemotherapy (Rituxan + chemo, like R-CHOP) as their first treatment.

As the researchers state in their conclusion, the study would suggest that many FL patients can hold off on chemotherapy and try Rituxan instead, and that for some, Rituxan can be enough.

Now, let's be clear -- the study is not saying that we are finished with chemo. Many patients in the study ended up needing treatment (including chemo) at a later time. The study suggests that for many patients, starting out with just Rituxan can be an option.

What makes the study important, in my non-expert opinion, is that it shows once again that it's possible to move away from chemo, and that the impulse to start with chemo might be challenged.

Of course, as someone who watched and waited for two years, and then took only Rituxan, and who hasn't needed treatment in over 8 years, I also like reading that my choice is kind of validated. It looks back at the past -- the fact that I'm still here is the thing that validates the choice -- but it's still nice to read.

Now, the most important lesson here -- talk to your doctor. Rituxan worked as an option for a particular set of patients in a specific study. It could work for some people. But traditional chemotherapy might be the best option for others. Talking things through with your doctor, asking informed questions, and perhaps seeking a second opinion are your best approaches to deciding on treatment.