LINFOM follicular non-Hodgkin stage IIE-IV
GENERAL Information
Patients presenting with non-Hodgkin's follicular lymphomas in stages IIE to IV are considered to have advanced disease and cannot be cured with standard treatment approaches. All follicular lymphomas presented below are treated in an identical manner.
International Labour formulation
Lymphoma Classification American European review
Indented small follicular cell
Central follicle cell (Grade 1)
Small and large mixed follicular cell
Central follicle Cell (Grade 2)
There is a wide variety of factors influencing patients ' decision to receive cancer treatment. The purpose of treatment may be to improve symptoms by local cancer control, increase patient healing possibilities, or prolong life. The benefits expected from cancer treatment should be carefully weighed with regard to your potential risks.
We present general information on the treatment of advanced follicular lymphoma. The individual circumstances of your situation and the prognostic factors of your type of cancer are what ultimately influences the way these general principles of treatment apply to your situation. The information on this website is an educational aid for you about treatment options and facilitates the decision making process, mutual or shared, with the medical oncologist who treats you.
Most new treatments arise from clinical experiments, i.e. from studies evaluating the effectiveness of new drugs or treatment strategies. The progress of the most effective treatments for cancer requires the evaluation of new and innovative therapies in cancer patients. Participation in a clinical experiment can provide access to better treatments and enable the advancement of existing knowledge in relation to the treatment of this cancer. Clinical experiments are available for most stages of cancer. Patients interested in participating in these experiments should evaluate their risks and their benefits in conjunction with their physicians. To make sure that you are getting the best treatment for your cancer, it is important to be aware of the latest news about cancer, so that you have knowledge about new treatments and the results of clinical trials.
Follicular lymphoma is considered a very indolent or slow-growing cancer. Because cancer growth is slow, it is very difficult to cure as traditional chemotherapy for cancer or treatments with radiation therapy destroys fast-growing cells. Although curing patients with advanced follicular lymphoma is unusual, patients can live a long time with their disease. In fact, the average life of patients with follicular lymphoma is 6 to 10 years from diagnosis.
Because follicular lymphomas are difficult to cure, many treatment strategies are now aimed at prolonging the time that patients can live with their disease. Since cancer grows slowly, initial treatment may not be necessary for many months to years after diagnosis. However, many patients will require early treatment. It usually starts a year later, for the following reasons:
To alleviate the symptoms caused by lymphoma, including fever, sweat, and weight loss.
Treatment may be necessary to prevent the growth of lymphoma in an area where it affects the function of other organs, such as a blockage of the kidneys.
Improve the low blood count caused by lymphoma involving the bone marrow, which increases the risk of infection, bleeding, or anemia.
Stop the growth or progression of lymphoma.
Patient preference: Some patients feel uncomfortable living with lymphoma and prefer to be treated even in the absence of the above reasons.
Due to the incurableness of follicular lymphomas, participation in a clinical experiment evaluating new drugs or treatment strategies is an appropriate initial treatment option.
Due to the wide range of existing treatment options for advanced follicular lymphomas, planning a treatment can be confusing. Although most patients with advanced follicular lymphoma are not cured with standard treatment options, all approved therapies approaches have been shown to improve survival. Each treatment is associated with unique side effects or toxicity. When a treatment is chosen, it may be most appropriate for some patients to select therapy with less toxicity, while other patients may want a treatment regimen based only on long-term survival without cancer. The patient may also consider how a treatment option may affect the next treatment decision in the event of a cancer relapse. Currently, the standard initial treatment available for advanced follicular lymphoma includes:
Individual agent chemotherapy: Clinical experiments have indicated that Fludara ® appears to be the most effective individual chemotherapy agent for the initial treatment of follicular lymphoma. As an initial treatment, Fludara ® only induces complete remissions in about 40% of patients. Other individual chemotherapy agents that are approved for the initial treatment of follicular lymphoma include the purine nucleoside analogue 2-Clorodeoxidenosina, the alkylating agent Ciclosfosfamida and the chlorambucil with or without steroids.
Chemotherapy drug combinations: many multi-drug chemotherapy regimens that can induce complete responses in more than 50% of patients are available. Usually, chemotherapy combinations used for the treatment of follicular lymphoma include, but are not limited to, the following:
The most commonly used chemotherapy combination is cyclophosphamide, doxorubicin, Oncovin ® and prednisone (CHOP).
Other combinations include:
CPV: Cyclophosphamide, Oncovin ® and prednisone.
C (M) OPP: cyclophosphamide, Oncovin ®, Procarbazine and prednisone.
FM: Fludara ® and Novantrone ® with or without dexamethasone.
In a recent clinical experiment it was suggested that FM may improve anti-cancer responses compared with CHOP as initial therapy in patients with follicular lymphoma; However, additional experiments are needed in order to confirm this finding.
Combination of chemotherapy plus Intron ® A (interferon): Many clinical experiments have shown that Intron ® a injected 3 times per week in patients who achieve a remission of combined chemotherapy can prolong the overall survival of Patients, compared with patients treated only with chemotherapy. In a recent experiment comparing Intron ® A with a combination of chemotherapy significantly prolonged survival and increased relapse time for cancer versus chemotherapy-only treatment.
Monoclonal antibodies: Rituxan ™ is a relatively new biologic therapy that is promising in patients with low-grade B-cell non-Hodgkin lymphoma or F
Olicular, in combination with chemotherapy or after standard treatment. Rituxan ™ is a monoclonal antibody that binds to proteins on the surface of B lymphocytes. This union stimulates the immune system to attack and eliminate cancerous B cells. The important benefit of this approach is that Rituxan ™ only focuses on cancer cells (B cells) avoiding the destruction of healthy cells. This, in contrast to chemotherapy or radiation that does not differentiate between healthy or cancerous cells in the body, is a feature that leads to potentially destructive side effects.
In a clinical experiment to evaluate Rituxan ™ as an initial treatment in 62 patients with indolent follicular lymphoma or small lymphocytic lymphoma (SLL), patients received a weekly Rituxan ™ cycle at the beginning of four Weeks. Patients whose disease did not progress during treatment received these 4-week cycles of Rituxan ™ every 6 months. Two years after treatment began, 67% of patients did not have a progression of cancer. There was No difference between the group of patients with follicular lymphoma and the group with SLL with respect to the response of the treatment. Only 3% of the patients showed infusion-related side effects that were reversible. No Other side effects were reported.
These results are favorable compared with other individual agents or standard combinations for the initial therapy of indolent non-Hodgkin lymphoma with minimal side effects. In addition, two-year survival with non-progression Rituxan ™ was superior in previously untreated patients, compared to historical clinical trials involving patients who received previous treatments for the disease . These findings are consistent with previous clinical experiments, which suggest that Rituxan ™ is well tolerated by patients and presents a high activity as an initial therapy for low-grade lymphoma. It can provide an alternative treatment option for elderly patients or for patients who cannot tolerate the side effects of chemotherapy. However, the optimal way to incorporate Rituxan ™ into the overall low-grade lymphoma treatment strategy is still under study.
In addition, the first treatment after original treatment with Rituxan ™ is promising in the treatment of lymphoma. In recent times, researchers assessed the safety and effectiveness of repeat treatment with Rituxan ™ in 58 patients with low-grade B-cell non-Hodgkin lymphoma or follicular lymphoma. All of these patients received pre-treatment with Rituxan ™, but showed relapse of cancer. In general, 40% of patients responded to the first treatment after the original treatment and, in fact, the second answers may be longer than the initial response after the first treatment. No significant side effects were presented to those of the first treatment.
Combined treatments: The combination of chemotherapy and monoclonal antibodies has demonstrated significant anti-carcinogenic activity in the treatment of patients with follicular lymphoma. Studies showed that the addition of Rituxan ™ to chemotherapy proved to improve anti-cancer activity compared to each of the treatments alone.
Clinical experiments have shown that chop chemotherapy plus Rituxan ™ is superior to chop solo in patients with indolent B-cell lymphoma. In a recent clinical experiment, 76% of patients who received Rituxan ™ plus chop achieved total or partial disappearance of the cancer, compared to 60% of patients who achieved total or partial disappearance of the cancer when they received the chop solo. A year after treatment, nearly 70% of patients who received Rituxan ™ plus chop survived without cancer progression, compared with 49% of patients who received only chop. Overall survival a year after treatment was 83% in patients receiving the combination of Rituxan ™ plus chop, compared to only 68% of patients who received only chop.
Strategies to improve treatment
The progress that has been made in the treatment of follicular lymphoma is the result of incorporating new anticancer agents in the treatment regimes and conducting clinical experiments. In the future, progress will be achieved from continued participation in appropriate clinical experiments. Today there are many areas of exploration to improve the treatment of follicular lymphoma
New chemotherapy regimens: Scientists continue to develop regimens for chemotherapy treatment with multiple drugs, which incorporates new or additional therapies for use as a cancer treatment. The combination of Fludara ® or other purine analogues with chemotherapy regimens is being investigated clinically.
Monoclonal antibodies: In recent times the Zevalin ™ monoclonal antibody was approved for the treatment of follicular lymphoma that stopped its response to standard therapies. Approval indicates that the Zevalin ™ should be used in combination with the Rituxan ®. Clinical trials are underway to determine whether Zevalin ™ may be effective in the early stages of this disease.
Zevalin ™ (90Yttrium-2b8 ibritumomab Tiuxetan) is a novel biological agent that has demonstrated important anti-cancer responses in the treatment of B-cell non-Hodgkin lymphoma. Zevalin ™ is a type of treatment that uses two separate strategies to focus and eliminate cancer cells. This is composed of Ibritumomab Tiuxetan, which is a monoclonal antibody that binds to a radioactive substance with the name of Yttrium 90 (90Y). The monoclonal antibody portion of the Zevalin ™ binds only to proteins on the surface of B cells. When Zevalin ™ binds to cancer cells, the immune system is stimulated to attack cancer cells while 90Y destroys these cells by spontaneously emitting radiation. This type of treatment not only provides two separate treatment strategies, but also allows the administration of large amounts of radiation to cancer cells when compared to external radiation therapy, while minimizing exposure of Radiation to normal cells.
The results of two large trials indicated that Zevalin ™ plus Rituxan ™ is safe and effective in the treatment of low-grade non-Hodgkin lymphoma. In the first experiment, 54 patients with low-grade B-cell non-Hodgkin lymphoma who no longer responded to chemotherapy or Rituxan ™, received Zevalin ™ plus Rituxan ™. The general anti-carcinogenic response rate was 74%. In the second experiment, 143 patients with low-grade B-cell non-Hodgkin lymphoma who did not respond to chemotherapy but also did not receive Rituxan ™ received the combination of Zevalin ™ plus Rituxan ™. The general anti-carcinogenic response rate was 80%. However, other studies are needed to determine at what point during the course of the disease and in which combination of treatment, Zevalin ™ can prove more effective in patients with B-cell non-Hodgkin lymphoma in low grade.
Treatments combined with monoclonal antibodies: Mayo Clinic researchers conducted in recent time an experiment to evaluate the efficacy of the addition of Proleukin ® to
Rituxan ™. Proleukin ® is a naturally occurring substance in the body's immune system. In some cases, Proleukin ® therapy only seems to stimulate the immune system against cancer. In this clinical experiment, 67% of the patients achieved an anti-carcinogenic response after Rituxan ™ and Proleukin ®, and 26% of the patients achieved a total disappearance of the cancer after therapy. Intermediate doses to high doses of Proleukin ® produced higher responses than low doses of this. These results appear to indicate that the addition of Proleukin ® to Rituxan ™ may increase anticancer effects; However, more trials are needed to determine the role of this combination of treatment.
Stem cell transplantation: high doses of chemotherapy and allogeneic stem cell transplants or autologous transplantation as a treatment for repeating non-Hodgkin follicular lymphoma were assessed. Administration of high doses of chemotherapy and allogeneic stem cell transplantation has been associated with a high mortality rate with 20 to 40% of patients dying from treatment complications within two years following transplantation. However, from 50 to 80% of patients survive without evidence of relapse of lymphoma for three or more years since treatment. These results are very encouraging and suggest that patients with follicular lymphoma can be curable. Since these patients were treated many technological changes have been presented that could reduce the mortality associated with this therapy. These technological changes combined with the early use of this therapy in patients with the disease should, without doubt, be associated with low levels of toxicity. In addition, the evaluation of high doses of chemotherapy and allogeneic stem cell transplantation or autologous transplantation as primary treatment for young patients with non-Hodgkin's follicular lymphoma is being conducted.
High doses of chemotherapy and autologous stem cell transplantation for the treatment of follicular lymphoma are also assessed in clinical trials. Long follow-up is needed to determine whether the anti-cancer responses achieved result in improvements in long-term survival compared to other standard treatments.
0 comments:
Post a Comment