Duration of Rituximab Maintenance in FL

Stephen M. Ansell, MD, PhD: The PRIMA trial is a study that actually completed almost 10 years ago. We now have long-term follow-up data that presented the use of rituximab maintenance in patients that received chemotherapy in combination with rituximab as frontline treatment for follicular lymphoma. The PRIMA trial looked at the use of rituximab maintenance, compared with observation or no maintenance, and showed a significant advantage for receiving rituximab maintenance. Patients in that trial received 2 years of maintenance therapy. With long-term follow-up, the data show that there’s continued improvement in the overall outcome in patients who receive maintenance therapy. It’s also safe, and the long-term complications and toxicities are well managed and modest.

The trial that Dr. Rummel and colleagues presented now looked at, should or could you do better if you actually give 4 years of maintenance therapy versus 2 years of maintenance therapy? And, what were the side effects and toxicities as one utilizes this approach? As it turns out, there may be some merit to a longer course of rituximab treatment. But, at this point, I think we’re going to need to see whether that’s something that is going to be incorporated into practice across the board.

Radhakrishnan Ramchandren, MD: My clinical practice, in terms of maintenance of rituximab, is such that I have a discussion with the patient about the benefits and cons of maintenance therapy. In general, I don’t just talk about side effects. I also discuss the progression-free survival benefit and the lack of overall survival benefit, as well as the potential to reutilize rituximab in the future in patients who don’t use maintenance therapy.

There is no singular guideline as to when and how to use this. But, once again, I would say that in those patients who have limited treatment options—again, as an example, for a patient who is elderly, in whom you think second- or third-line therapy is not practical—rituximab maintenance may be particularly important.

On the other hand, patients who have a good response to induction chemotherapy and are not inclined to come in on a monthly basis for a continued treatment, or patients who have side effects from rituximab, would not be ideal candidates for rituximab maintenance, in my opinion.

Transcript Edited for Clarity