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Professor Stephen Opat |
An international collaborative study, including researchers
at Monash University, has shown that follicular lymphoma patients treated with
a therapy known as obinutuzumab in combination with chemotherapy leads to
significant improvements in how the disease is controlled.
Published last week in the prestigious New England
Journal of Medicine, the results from the largest ever follicular lymphoma clinical
trial revealed that patients treated with a combination of chemotherapy and
obinutuzumab had their disease under control for one and a half times longer
than the standard treatment with chemotherapy and rituximab.
Non-Hodgkin lymphoma (NHL) is the sixth most common form of
cancer, affecting 1 in 40 people. NHL is
categorised into two main types: aggressive and indolent.
“In aggressive NHL, the lymphoma cells divide quickly and
patients die within months if untreated, however, most have a high chance of
cure with chemotherapy,” Head of Haematology at Monash University and Monash
Health, Professor Stephen Opat said.
“Follicular Non-Hodgkin lymphoma is the main subtype of
indolent NHL, a disease where lymphocytes (the immune cells that cause
lymphoma) don’t die and gradually accumulate in the lymph nodes, bone marrow
and tissues,” Professor Opat, senior author on the study said.
While indolent NHL patients can live for many years
untreated, the disease is considered incurable with chemotherapy, and treatment
is generally reserved for patients with symptoms.
Professor Opat said these patients often have an extended
period of disease control with chemotherapy, however the majority will
eventually relapse needing further therapy.
The Gallium study was the largest clinical trial ever
conducted in follicular lymphoma, comparing the safety and effectiveness of two
different anti-lymphoma antibodies (rituximab and obinutuzumab) in combination
with chemotherapy for patients with previously untreated follicular lymphoma.
1202 patients—including 30 at Monash Health, the largest
recruitment site in Australia—were randomly selected to receive chemotherapy
with rituximab or chemotherapy with obinutuzumab.
“Those patients who responded could have up to two years of
maintenance treatment with rituximab or obinutuzumab to keep their disease in
remission for as long as possible,” Professor Opat said.
After three years of follow up, more patients are still
alive with their lymphoma under control in the obinutuzumab group (80 of every
100) than the rituximab group (73 of every 100).
“This translates into a 1.5-times longer time that their
lymphoma is in remission with obinutuzumab compared with the rituximab—perhaps
offering an additional three years before needing to be treated again,”
Professor Opat said.
While the
obinutuzumab-treated patients had a longer period of lymphoma control they also
reported more frequent adverse effects of therapy including infections (20% versus
16% with Rituximab) and reactions to the antibody infusion (12% versus 7% with
rituximab).
“Chemotherapy with obinutuzumab resulted in a meaningful
improvement in the duration of disease control and is an important addition to
the treatment options for patients with follicular lymphoma.”