Rituxan (generic: Rituximab)

In 1997, the FDA first approved Rituxan (rituximab) for the treatment of indolent non-Hodgkin's lymphoma.¹ In that short time, few anti-cancer drugs have had the incredible impact on the lives of patients the way Rituxan has; the drug has single-handedly improved the prognosis for lymphoma patients^,2 an improvement measured in years.

Contrary to popular perception, Rituxan is not a chemotherapeutic, cytostatic drug; rather, it is a monoclonal anti-CD20 chimeric antibody. We can better understand how Rituxan works by examining these terms:

Monoclonal: Rituxan is made using identical cells that have been cloned (-clonal) from a single (mono-) cell.

Anti-CD20: CD20 is a protein expressed on the surface of B-lymphocytes; Rituxan identifies this as an antigen and kills the accompanying cell.

Chimeric: Rituxan originally was developed using mice antibodies before producing humanized antibodies; the term 'chimeric' recognizes the drug's dual species origin.

Antibody: An antibody is what the immune system uses to kill foreign antigens; Rituxan is designed as an antibody that does what the immune system cannot: identify cancerous cells as antigens and kill them.

What it's effective for and why

Multiple studies have proven Rituxan's treatment efficacy, and it is now considered a standard component of anti B-cell therapy,³ as a single agent, in maintenance therapy, and in combination chemotherapy (i.e. with CHOP, EPOCH, Zevalin, fludarabine, etc). Subtypes for which Rituxan has been FDA approved include follicular lymphoma, diffuse large B-cell lymphoma and chronic lymphocytic leukemia (small lymphocytic lymphoma). It continues to be explored as a potential treatment in other B-cell NHL subtypes, and is currently in Phase II trials to be added to standard ABVD therapy in the treatment of Hodgkin's lymphoma.⁴

Rituxan side effects: Overview

For all its efficacy, Rituxan does sometimes cause unpleasant side effects.⁵ They include nausea, vomiting, muscle/back pain, night sweats, fatigue, and weakness. In rare cases, Rituxan can also cause more serious side effects, such as unusual bruising, tightness in the chest, joint pain, and signs of infection (e.g. sore throat, fever). Additionally, in especially rare cases, Rituxan has been linked to a fatal brain virus known as progressive multifocal leukoencephalitis, or PML.⁶

References

Genentech: Rituxan
"Sehn LH et al. " The revised International Prognostic Index (R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP." Blood. 2007 Mar 1;109(5):1857-61. PMID: 17105812
Hauptrock B, Hess G. "Rituximab in the treatment of non-Hodgkin's lymphoma." Biologics. 2008 Dec;2(4):619-33. PMID: 19707443
ClinicalTrials.gov: Phase II R-ABVD Versus ABVD for Advanced Stage Classical Hodgkin Lymphoma
MedlinePlus: Rituximab side effects
Lymphoma Information Network: Rituxan linked to PML

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