Lymphoma cell. Credit: EM Unit.
New clinical trial results show that adding rituximab to standard chemotherapy could improve survival for children and young people with a type of non-Hodgkin lymphoma.
Lymphomas are the third most common group of children’s cancers in the UK, and high grade, B cell non-Hodgkin lymphoma tends to grow more quickly than other forms of the disease. Right now, these lymphomas are treated with chemotherapy alone.
Dr Amos Burke, a childhood cancer specialist who led the UK arm of the trial, called the findings “a huge step forward”, adding that this marked the most significant breakthrough in treating this type of cancer for 30 years.
A targeted cancer treatment
The new therapy combines rituximab with the standard chemotherapy currently used to treat this type of non-Hodgkin lymphoma in children and young people.
A targeted cancer drug, rituximab works by sticking to a protein called CD20 on the surface of leukaemia and lymphoma cells, making it easier for the immune system to identify and kill the cancer.
While rituximab has already been shown to increase survival for adults with diffuse large B cell lymphoma and Burkitt lymphoma, research confirming the safety of its use in children and young people has so far been limited.
The latest clinical trial analysis, published in the New England Journal of Medicine, involved 328 children and young people aged between 2 and 18 years, with recruitment in 12 different countries. The trial tested the benefits of adding 6 doses of rituximab to standard chemotherapy treatment.
In the trial, children taking both rituximab and chemotherapy were more likely to be alive 3 years after starting treatment than those taking just chemotherapy. Adding rituximab also reduced the likelihood of there being any disease left after treatment and increased the time before a child’s cancer came back.
After 3 years, 94% of children and young adults taking rituximab alongside chemotherapy were alive without any signs of cancer, compared with 82% of those taking just chemotherapy.
And initial analysis suggests that rituximab could improve overall survival as well. But more data is required to provide information on the long-term safety of the treatment combo, which was found to induce more cases of hypogammaglobulinemia – a problem with the immune system that prevents it from making enough antibodies – than chemotherapy alone.
A huge step forward
Funded by Cancer Research UK, scientists from the UK arm of the trial have said the addition of rituximab to children’s and young people’s treatment represents a huge step forward in the treatment of this aggressive cancer.
“These are practice changing results which define a new standard for high risk B-NHL in children and young adults,” says Burke. “It represents the most significant improvement in survival since the 1990s for this disease.”
Professor Pam Kearns, director of the Cancer Research UK Clinical Trials Unit at the University of Birmingham adds: “This trial is a huge step forward for children and young people with the most aggressive type of non-Hodgkin lymphoma which has resulted in a change to standard treatment.
“It’s also a fantastic example of what can be achieved with global research collaboration, something which is essential if we’re to drive progress of rarer types of cancer, including children’s and young people’s cancers.”
Minard-Colin V et al., (2020) Rituximab for High-Risk, Mature B-Cell Non-Hodgkin’s Lymphoma in Children. New England Journal of Medicine. DOI: 10.1056/NEJMoa1915315