New Study Could Change Treatment Strategy in Follicular Lymphoma

Results of a new study could have major implications for patients with follicular lymphoma (FL).

Results from RESORT (Rituximab Extended Schedule or Retreatment Trial) indicate that in patients with low-tumor burden FL, a strategy termed 'rituximab retreatment' is as effective as rituximab maintenance in controlling the disease, but requires less of the drug.

"The RESORT trial demonstrates that single agent rituximab, administered in a retreatment strategy (RR), is as efficacious as MR [maintenance rituximab] in low-tumor burden FL," reported Brad S. Kahl, MD, University of Wisconsin School of Medicine and Public Health, Wisconsin Institute for Medical Research, Madison, and colleagues from the Eastern Cooperative Oncology Group (ECOG) in the Journal of Clinical Oncology.

According to their findings, when rituximab is given as a single-agent therapy in these patients, "a strategy of retreatment at disease progression [RR] is recommended over a strategy of continuous maintenance therapy [MR]."

This is a significant recommendation, considering how widespread rituximab maintenance is in current clinical practice guidelines in oncology.

For this randomized clinical trial, 408 patients with low-tumor burden FL were enrolled.

Patients were administered four weekly doses of rituximab (375 mg/m2). A total of 289 patients (71%) responded. They were subsequently randomized to one of two rituximab dosing schedules. 143 patients were assigned to the RR group and were put on watch-and-wait until the development of symptoms or high tumor burden. At that time they were eligible for retreatment at each disease progression until treatment failure. 146 patients assigned to the MR group were administered a single dose of rituximab every 13 weeks until treatment failure, in line with maintenance therapy.

Treatment failure was defined as no response to RR, or in the MR group, progressive disease between scheduled rituximab doses.

The median amount of rituximab received by each arm differed drastically: in the retreatment (RR) arm, the median number of doses patients received was four. Maintenance patients received a median of 18.

According to the results, and set against pre-established endpoints, there was very little difference between the two arms in terms of time to treatment failure and toxicity. Furthermore, after five years the overall survival rate (94 percent) was the same.

What does this mean? For follicular lymphoma patients who would ordinarily be put on rituximab maintenance, it could mean a different strategy, one that involves receiving significantly less rituximab while achieving the same results.

Source: MedPage Today: Rituximab Re-Up Strategy is Drug Sparing Strategy