Monoclonal antibody therapy is different from chemotherapy and radiotherapy because it targets lymphoma cells more specifically with less damage to normal cells. It does this by recognising and attaching to a specific substance on the surface of cells, which helps the cells to die and the immune system to attack them. One man had an antibody called CamPath (alemtuzumab) as part of preparation for a stem cell transplant.
Most people we spoke to who received immunotherapy had an antibody called rituximab or Mabthera, which targets a substance present on the surface of most B lymphocytes called CD-20. This treatment is therefore only suitable for people with B-cell non-Hodgkin lymphomas. At the time many of the people we talked to were treated, rituximab was a new treatment and not routinely available to everyone in the UK through the NHS.
Some got the treatment through having private health care, while another said his consultant had been permitted to give it to him before NICE had approved it. One had it because he lived in Scotland where it became available earlier than in England, and another moved area in order to obtain it (see ‘Treatment decisions’).
Could be given rituximab as first line treatment before it was generally available because she…
Had first line treatment of rituximab with CHOP chemotherapy because it was available earlier in…
Rituximab was often used as a first line treatment in combination with chemotherapy such as CHOP, CVP or VP. One person had a single dose of rituximab between two doses of ESHAP chemotherapy. People whose lymphoma had relapsed were given rituximab either alone or combined with chemotherapies such as FMD or PMitCEBO although it is much more usual to have ICE or bendamustine now for relapses. Rituximab is infused into a vein; the first infusion is quite slow as some people suffer a bad reaction to it. Later infusions can be given more quickly. Most people were treated as an outpatient, but a few stayed overnight for the first infusion. The most common side effects of antibody therapy are flu-like symptoms; but some people experienced none.
Describes what it was like to have CHOP chemotherapy and the first slow infusion of rituximab.
Felt faint during her first rituximab infusion so it was stopped and restarted when she had…
Had a severe allergic reaction to the first infusion of rituximab so it was stopped and restarted…
Had no side effects from rituximab and said that it was much easier to tolerate than chemotherapy.
In July 2009 rituximab was approved by NICE for:
- Treatment of diffuse large B cell lymphoma (high grade)
- Combined with chemo as initial therapy of low grade lymphomas
- Maintenance of first response in low grade lymphomas.
Rituximab is now widely available on the NHS.
In June 2011 rituximab was approved by NICE for:
‘A possible treatment to maintain remission in people with follicular non-Hodgkin lymphoma. You should be able to have rituximab maintenance treatment if your follicular non-Hodgkin lymphoma has already responded to rituximab when given in combination with chemotherapy.’
Another type of monoclonal antibody therapy involves attaching a radioactive substance to a CD-20 antibody to deliver a dose of radiation directly to the lymphoma cells (radioimmunotherapy). Radioactive monoclonal antibodies that may be used to treat NHL include ibritumomab tixuetan (Zevalin) and tositumomab (BEXXAR). BEXXAR and Zevalin are not widely available in the UK and have not yet been assessed by NICE. This type of treatment has generally been used for people who have already had chemotherapy and rituximab or those whose lymphoma has not responded to other treatments. Some people we spoke to had been treated with a radiolabelled CD-20 antibody called Zevalin. They were given a single dose infused over 10-15 minutes from a syringe preceded by two doses of rituximab, one a week before the Zevalin, the other a few hours before. Side effects were nausea and aching, which subsided within a few days. They had to avoid close contact with other people for a couple of weeks to avoid contaminating them with radioactivity.
Had to be treated with Zevalin in a different hospital; explains how it was given, how he felt…
His suitability for having Zevalin was assessed, he had two treatments with rituximab before the…
He was excited to be treated with the new drug Zevalin and the staff watched with curiosity.
Less specific immune stimulants have also been used, including interferon. One man, diagnosed in 1993, was given interferon, which he or his wife injected three times a week under his skin for two years; then his lymphoma relapsed. Nowadays this drug is more commonly used to treat other types of cancer.
Alemtuzumab (MabCampath) is another monoclonal antibody that attaches to a protein that is found on the surface of B-cell and T-cell lymphocytes. It is only available for treating lymphomas as part of clinical trials. It’s being tested in clinical trials as a treatment for some types of T-cell lymphoma and in combination with chemotherapy before a transplant. Several other monoclonal antibodies are also being developed and these may be offered as part of research trials.