Reduced Quality of Life?
Taking up the issue of quality of life, Dr. Vose called attention to the time and inconvenience of rituximab maintenance.
“Is coming in every few months or every week to get rituximab at the cancer center a good quality of life, or is it a better quality of life to go about your activities and, eventually, when the lymphoma may come back, to come back in for treatment?” she asked.
A final concern she mentioned is the emergence of resistance. “As these patients are treated over and over and over again with rituximab, they do become rituximab refractory,” she said, and refractory disease is very difficult to treat.
“Maintenance rituximab should be used in a very limited fashion,” Dr. Vose asserted. “Currently, there is very little evidence for a survival benefit in most of our trials, and re-treatment at relapse provides a very similar benefit.”
When using maintenance rituximab, she recommended that clinicians refer to clinical trial results and guidelines for guidance.
In particular, patients in trials have generally been treated for 2 years at most, whereas patients in clinical practice are often being treated for much longer.
“I think that’s not appropriate,” she concluded. “We have to be concerned about the long-term effects.”
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