WHAT IS MAINTENANCE THERAPY?
Maintenance therapy refers to the ongoing treatment of people whose disease has responded well to treatment (sometimes called ‘induction’). An increasing number of treatments have emerged that have shown to be effective at keeping cancer in remission. Maintenance therapy typically consists of nonchemotherapy drugs given at lower doses and longer intervals than when they are given during initial therapy. They are usually started within the first 6 months following initial treatment to keep lymphoma from progressing or recurring
LENGTH OF DURATION OF MAINTENANCE THERAPY
Depending on the type of lymphoma and the drugs used, maintenance therapy may last for weeks, months, or even years. Not all people are recommended to have maintenance therapy if their lymphoma is under control after induction treatment. Rituximab (Rituxan or Mabthera) is a targeted immunotherapy that is often recommended as maintenance therapy in patients with many different forms of non-Hodgkin lymphoma (NHL). These people have usually received rituximab as part of their induction therapy, most commonly in combination with chemotherapy. If the lymphoma responds to initial treatment, rituximab may be recommended to be continued as ‘maintenance therapy’. The rituximab in the maintenance phase is administered once every 2–3 months. Rituximab is currently given for a maximum period of 2 years, although clinical trials are testing whether there is any benefit in maintenance treatment continuing for longer. For maintenance therapy, rituximab may be given intravenously (by injection into a vein) or subcutaneously (by injection under the skin). Alternatively, obintuzumab (Gazyva) is another monoclonal antibody that is also used for maintenance for patients with follicular lymphoma post chemotherapy with obintuzumab, administered every 2 months for 2 years.
WHO IS GIVEN MAINTENANCE THERAPY?
Maintenance rituximab has mainly been used in the indolent NHL sub-types like follicular lymphoma and mantle cell lymphoma, but is currently also being looked at in other subtypes of lymphomas. Children and young people with lymphoblastic lymphoma may be given maintenance treatment with chemotherapy to prevent their lymphoma relapsing. This is a less intensive course of chemotherapy and is usually given as an outpatient over a couple of years. Rituximab is not currently approved for use in children.
WHAT ARE THE BENEFITS OF MAINTENANCE THERAPY?
Rituximab has shown to increase the length of remission in people with lymphoma, regardless of whether they have been previously treated or this was their first treatment course. There are many newer treatments for lymphoma that are being trialled for their use as maintenance therapy to reduce the risk of the lymphoma relapsing (coming back). The introduction of maintenance therapy in the treatment of indolent lymphoma represents a proactive approach to prolong remission rather than waiting to treat them when the disease has relapsed.
New hope for lymphoma is always on the horizon. Data has shown that relapses can be delayed or even prevented, by continuing or ‘maintaining’ treatment with rituximab while people are in remission. The goal is to prevent those people who have responded to initial treatment from relapsing while ultimately improving overall survival.
WHAT ARE THE RISKS ASSOCIATED WITH MAINTENANCE THERAPY?
Although the drugs used for maintenance treatments generally have fewer side effects than combination chemotherapy, people may still experience adverse events from these treatments. Your doctor will consider all of your clinical circumstances before determining your initial treatment and whether you would benefit from maintenance therapy versus another treatment or ‘watch and wait’.
Some of the possible side effects of maintenance Rituximab are:
- Allergic reaction
- Lowering effects on blood cells. You will have regular blood tests done to check the numbers of blood cells
- Headaches or flu like symptoms
- Fatigue or tiredness
- Skin changes. Rituximab may cause a rash, which can be itchy. You may also notice unusual feelings in your skin such as numbness, tingling, pricking or burning
TREATMENTS UNDER INVESTIGATION
Many new individual and combination therapies are being trialled around the world for their use in maintenance therapy for lymphoma. Some of these drugs include:
- Bortezomib (Velcade)
- Brentuximab vedotin (Adcetris)
- Lenalidomide (Revlimid)
- Vorinostat (Zolinza)
Scientific research is continuously evolving. Treatment options may change as new treatments are discovered and treatment options are improved. It is important to check with your Haematologist or Oncologist for any treatment updates that may have recently emerged.
RESOURCES AND SUPPORT
SOME QUESTIONS TO ASK YOUR DOCTOR
- Is maintenance therapy an option for me?
- Why are you recommending maintenance therapy?
- What are the benefits and risks?
- How often and for how long will I receive this treatment?
- What type do you recommend?
- Is this better for me than being re treated or “watch and wait”?
