New treatment rivals chemotherapy for lymphoma

A new form of treatment for lymphoma—one that doesn't take as long as traditional chemotherapy and has fewer side effects—shrunk tumors in 95 percent of patients, a new study by researchers at the Comprehensive Cancer Center (CCC) found.

Researchers gave patients with advanced-stage follicular lymphoma—a cancer generally considered incurable—one treatment with the Bexxar therapeutic regimen, a radioactive antibody injected into the bloodstream that targets and kills cancer cells. None of the patients previously had been treated with any other form of therapy.

Of the 76 patients enrolled in the study, 95 percent had some response to the treatment and 75 percent had a complete response, meaning no evidence of cancer remained. More than three-quarters of patients with a complete remission were disease-free after five years.

Results of the study appear in the Feb. 3 New England Journal of Medicine.

"The results of this treatment, which essentially takes only one week to complete, rival any kind of treatment that's been used for follicular lymphoma, including chemotherapy regimens that take months to complete," says lead study author Dr. Mark Kaminski, director of the CCC's Leukemia/Lymphoma Program and the Multidisciplinary Lymphoma Clinic. "It's very well-tolerated by patients and we saw complete remission in the majority of patients lasting for years."

Kaminski and colleague Richard Wahl, formerly at U-M and now at Johns Hopkins University, developed the Bexxar regimen, which received approval from the U.S. Food and Drug Administration in June 2003 to treat follicular non-Hodgkin's lymphoma after other treatments have failed. The newly published research involves Bexxar as a first-line treatment for this disease.

Non-Hodgkin's lymphoma, the nation's sixth-leading cause of cancer death, is a disease of the lymph system, which is part of the immune system. Lymphoma spreads easily through the lymph system and the bloodstream and consequently tends to be widespread when it is diagnosed.

Bexxar, whose chemical name is tositumomab and iodine I 131 tositumomab, combines an antibody that seeks out cancer cells, and a radioactive form of the element iodine. When injected, it travels like a guided missile through the bloodstream to bind to a protein found on the surface of the cancerous cells. The radiation zaps these malignant cells with minimal exposure to normal tissues.

With the Bexxar therapeutic regimen, a patient receives an injected test dose of radioactive Bexxar to determine how that patient's body processes the tagged antibody. One to two weeks after that initial dose, the patient receives a custom-tailored therapeutic dose, and therapy is considered complete.

Results from the study are even more promising than results using Bexxar after other therapies have failed. In those studies, 70 percent of patients responded to Bexxar and 20 to 30 percent saw a complete remission.

"Given how much better this treatment worked as first-line therapy in our study, moving this treatment up earlier in the course of a patient's illness should be strongly considered instead of using it as a last resort or not at all," says Kaminski, a professor of internal medicine at the Medical School. "These results support the notion that there's a real possibility of putting chemotherapy on the back burner for this disease. New studies can be designed to begin to test this possibility," he adds.

In addition to Kaminski, U-M study authors are Melissa Tuck, research associate for hematology/oncology; Judith Estes, nurse practitioner in the lymphoma clinic; Dr. Charles W. Ross, associate professor of pathology; Denise Regan and Paul Kison, nuclear medicine technicians; Susan Fisher, project associate in radiology.

The National Cancer Institute, the National Institutes of Health and the Corixa Corporation paid for the study. U-M holds patents for the Bexxar therapeutic regimen, which is marketed by GlaxoSmithKline under a licensing agreement. U-M receives royalties on sales of Bexxar, a portion of which goes to Kaminski and his co-inventors.

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