ASH: Rituxan Maintenance

I am very, very slowly working my way through the ASH abstracts.

I don't think this is going to be a big year for Follicular Lymphoma. Nothing that I can see as challenging what we know. I could be wrong, of course. Sometimes something happens during a conference that hadn't been obvious in the abstract, and there's only a lot of chatter online about it after the conference is over.

As always, it will be interesting to see what kind of press releases and announcements happen during and after the conference to see who's bragging about their work.

But from I can see, there's a lot of new treatments that are small improvements over what we have, or new studies on controversial topics that don't really resolve the controversy.

The first one to catch my eye is one of those "controversy" topics.

Rituxan Maintenance has been controversial for as long as I've been reading about it.

The controversy is usually over whether or not it's worth it. Some studies say it prolongs Progression Free Survival, and others say it doesn't. Some say it causes Rituxan to stop working, or to raise the risk of infections. Others say the opposite.

At this year's ASH, there is a study that looks at long-term and short-term use of Rituxan Maintenance. It's called "Rituximab Maintenance Treatment for a Maximum of 5 Years in Follicular Lymphoma: Final Results of the Randomized Phase III Trial SAKK 35/03."

This study work on the assumption that Rituxan Maintenance is a good thing. Instead of comparing a group of people on Maintenance to a group of people who didn't have it, it looks at a group of patients that had short-term Maintenance (6 months) and one that had it long-term (5 years).

They looked at 165 patients, half in each group. All of the patients had 4 weekly rounds of Rituxan. If the patient had a Partial or Complete Response, they were moved into one of the two Maintenance groups. The patients were followed for a median of 10 years.

What they found was that, even after 10 years, there was no significant difference between the two groups in Event Free Survival, Progression Free Survival, or Overall Survival.

The implication is that getting Rituxan Maintenance for a very long time doesn't help much. It ends up costing a lot more, and potentially causing some of the problems that other studies have shown it to cause.

From what I've read, two years seems to be the most common length for Maintenance. (I don't have any data to back that up -- just my sense from reading a lot). If that's the case, then even two years seems like it could be more than necessary.

One thing that I found especially interesting in the study is that it looked at Rituxan as the primary treatment before the Maintenance. Some patients hadn't had any treatment at all, some had chemotherapy before this study, and some may have had other treatments. But when I mentioned Maintenance to Dr. R so many years ago, he said there wasn't really a benefit to following just Rituxan with Maintenance. Any benefit seemed to come from following R+chemo with Maintenance. I don't know off hand if there are any studies that would show that there is a benefit now, but this study seems to be working on the assumption that there is.

The big picture, though, is that, like pretty much every other study of Rituxan Maintenance, there isn't going to be a final answer that comes out of this.

The best thing you can do it have a talk with your doctor and decide what's best for you.

More ASH to come.