Rituximab's Value Shown in First-Line Treatment of Follicular Lymphoma

The monoclonal antibody rituximab (Rituxan), when added to standard chemotherapy as a first-line treatment for follicular lymphoma, significantly delayed the progression of the disease and produced higher response rates, according to findings reported at the American Society of Clinical Oncology (ASCO) annual meeting last week by Dr. Kevin Imrie of the Toronto-Sunnybrook Regional Cancer Center in Canada.

Early results of the trial appeared in Blood in February, but the more extensive analysis Dr. Imrie reported provides "the first hard evidence that rituximab's demonstrated efficacy with recurrent disease" in follicular and other types of lymphoma extends to first-line treatment.

Previously untreated patients with advanced follicular lymphoma were randomly assigned: 162 patients received rituximab plus a standard first-line chemotherapy regimen of cyclophosphamide, vincristine, and prednisone (CVP); another 159 patients received CVP alone. After four cycles, only those patients who had responded remained in the study and received the final four cycles of whichever regimen they had begun.

Significant differences were seen for nearly all measures in favor of the rituximab-plus-CVP arm. About 81 percent of patients responded to rituximab therapy compared with 57 percent of patients in the CVP-only group. The rituximab patients had a longer median time before their cancer stopped responding to treatment (27 months vs. 7 months) and a longer median time during which their cancer continued to respond to treatment (35 months vs. 14 months). Side effects incidence was similar for both groups.

ADD Drug Shows Effectiveness Against "Chemobrain"

Researchers at the ASCO annual meeting last week reported that the use of a central nervous system stimulant significantly moderated cognitive dysfunction in patients previously treated with adjuvant chemotherapy. The data come from a phase III clinical trial testing the drug dexmethylphenidate, or d-MPH (Focalin) - a drug approved by the FDA for the treatment of attention deficit disorders - in patients with cognitive dysfunction following chemotherapy, a condition sometimes referred to as "chemobrain."

The study randomized 152 adult patients to treatment with d-MPH or to a control group. All patients had completed at least four cycles of chemotherapy for a variety of cancers. The vast majority of patients, 94 percent, were women with either breast or ovarian cancer. Only 132 patients completed the 8-week study, with the majority of dropouts related to adverse events, such as headache and nausea.

The treatment group showed weekly improvements in alertness and general cognitive function as measured by standardized assessment tools used in clinical trials, reported the study's lead author, Dr. Elyse Lower of the University of Cincinnati. Although the study was not designed to assess memory dysfunction, the treatment group showed significant improvement. But some of the overall assessment tools, she cautioned, did not show a statistically significant difference between test groups.

Laparoscopic Surgery for Colon Cancer Found Safe and Effective

Laparoscopic-assisted surgery for colon cancer is as effective as open surgery in the short term and is likely to produce similar long-term outcomes, according to a study reported in the May 14 Lancet.

Dr. Pierre J. Guillou and colleagues at the Medical Research Council (MRC) in the United Kingdom conducted a multicenter, randomized trial (dubbed CLASICC) of 737 colorectal patients during 1996-2002, comparing the standard open surgery with laparoscopic-assisted operations. About two-thirds of the patients were randomized to the laparoscopic treatment.

"Pathological analyses indicated high-quality surgery in both treatment groups, with high lymph-node yield equaling or exceeding that in several other trials," the researchers reported. "Our short-term results lend support to those of previous studies, which show that for colon cancer, the laparoscopic procedure is oncologically safe, that local recurrence rates will be no higher than for open surgery, and that cancer-related survival will be at least no lower than after conventional resection."

In an accompanying editorial, Stanford University professor Dr. Myriam Curet said this finding is reassuring for surgeons who have been concerned about earlier, smaller studies reporting higher rates of recurrence of colorectal cancer after laparoscopic operations.

However, for patients undergoing anterior resections for rectal cancer, MRC researchers found that a "nonsignificant difference in CRM (circumferential resection margin) positivity was recorded, suggesting that the laparoscopic procedure could be associated with a slightly raised risk of local recurrence." The researchers did not recommend routine use of the less-invasive procedure in those cases.