Erfahrung mit Rituximab Monoth. als First Line und Second Line (FNHL Grad1, Stad. 3A

[jimbolaya]

so liebe Leute..

der Vollständigkeit halber poste ich meine Erfahrungen mit der Rituximan-Mono-Therapie hier auch noch: nach 4 Gaben Rituximab war ich seit Dezember 2011 in kompletter Remission :-) Gestern wurden jedoch wieder vergrößerte Lymphknoten festgestellt, sodass die Remission 5,5 Jahre gehalten hat.

Ich habe auch nochmal etwas recherchiert zu folgendem Thema und möchte euch meine Recherche-Ergebnisse nicht vorenthalten:

Rituximab Resistance nach einer Rituximab-Mono-Therapie / schlechte Prognosen durch Rituximab First Line :-(

For both aggressive and indolent subtypes of NHL, there is no standard of care for salvage regimens, with prognosis after relapse remaining relatively poor.

While therapeutic outcomes has dramatically improved in the post-rituximab era, there is increasing evidence of rituximab resistance.

In patients with relapsed FL or low-grade NHL who had previously received single agent rituximab, only 40% of patients responded with rituximab retreatment. However, patients with prior rituximab treatment had significantly worse progression-free survival (PFS) than patients who were rituximab-naïve (17% vs 57%). Prior rituximab treatment was an independent adverse prognostic factor for survival.

Poorer outcomes were specifically seen in previously treated rituximab patients who relapsed or progressed during the first year.

These data and others highlight the clinical concern that salvage regimens for relapsed/refractory patients may not be as effective in the era of rituximab usage in front-line regimens.

To address these issues [with Rituximab Resistance], one major treatment strategy has been the development of novel anti-CD20 antibodies that more effectively engage immune effectors and bind CD20 with higher avidity. Several of these next-generation anti-CD20 antibodies are in late-stage clinical development. Other nonantibody therapies have also been demonstrated to enhance CD20 expression changes and/or sensitize tumor cells to rituximab in the hope of overcoming rituximab resistance.

Ofatumumab binds to both the small and large extracellular loops (ECL) of CD20 molecule, and is more effective than rituximab at killing target cells. It has been shown to be more potent than RTX against both RTX- sensitive and resistant cells.

In a phase 3 trial including 116 FL patients previously treated with rituximab or rituximab-containing chemotherapy, ofatumumab monotherapy was well tolerated, but it showed an overall response rate (ORR) of only 10% in the 86 patients who received the highest dose (1000 mg/8 weekly doses)

Quelle: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775637/

Das klingt für mich leider ein bisschen danach, als ob Rituximab in der First Line Therapie doch nicht so sinnvoll war. Ich hoffe, jetzt findet sich jemand, der mir in diesem Punkt begründet widerspricht :-)