Suggested Treatment Regimens
The National Comprehensive Cancer Network (NCCN) is an alliance of 21 of the world's leading cancer centers. For nearly every type of cancer, specialists from those 21 centers develop what is known as "NCCN Practice Guidelines For Oncology" which are recognized standards for clinical policy in the oncology community. Updated annually, these guidelines are based on the evaluation of data which is integrated with the expert judgment of a multidisciplinary panel of experts.
The 2007 edition of the Guidelines was published in June. It states that initial treatment for lymphoma requires consideration of many factors and thus treatment selection is highly individualized. It also lists the following options as "Suggested Treatment Regimens" for first line therapy:
R-CHOP
R-CVP
R-Fludarabine
R-FND (fludarabine, mitoxantrone, dexamethasone)
Rituxan
RIT
R-CHOP followed by RIT
For second-line and subsequent therapy, suggested treatment regimens are:
Autologous transplant
Allogeneic transplant (for highly selected patients)
Chemotherapy (same as first-line chemotherapies)
RIT
It is noted that RIT as front-line therapy is recommended in a clinical study. It is also noted that Rituxan maintenance therapy after first or second treatment is recommended in a clinical study as "no benefit in overall survival has been demonstrated." I found these notes particularly interesting since maintenance therapy has become so widespread and the use of RIT is so minimal.
So - how do you choose a treatment? Unfortunately, the options have never been compared to each other in a controlled scientific setting, but no study has yet demonstrated the results of RIT. Those studies indicate that RIT produces the longest, most durable remission periods in the greatest number of patients, especially when used earlier in treatment rather than later, i.e., after two or more failed chemotherapies.
While age, overall health and disease-specific factors will influence each individual's treatment, RIT is an option that is all too underutilized by the oncology community. If you think you may be a candidate for RIT, it would be well worth your time and energy to explore it as a possibility and to seek the advice of a hematologist/oncologist who is familiar with the treatment.
Betsy