The role of targeted therapy in non-Hodgkin lymphoma (NHL) is being explored, tested, reported and argued about almost continuously in the medical oncology literature. Rituximab, a highly specific monoclonal antibody that binds to an antigen called CD20 on B-lymphocytes, is commercially available and has been studied extensively. It is quite active against both indolent and aggressive NHL.

Whether rituximab prolongs survival in this disease is still to be determined. Also unresolved, by the way, is when to use it, what other agents to use it with, how frequently to use it, how long to use it, and which patients will benefit the most from receiving it. This might just explain why clinical research against cancer takes a while to produce treatments that can be considered new standards of care!

To get a peek at how researchers are trying to resolve this issue, go to this report from the medical journal Blood. This study showed that previously untreated patients with advanced indolent lymphoma who received chemotherapy plus rituximab had a higher response rate, higher complete response rate, a prolonged time to progression, and a longer median time to treatment failure than patients who only received chemotherapy alone. Toxicity was no worse in the group treated with rituximab.

Sounds like the controversy is over, right?

Wrong – the reason why is outlined in this accompanying editorial. [Hint: read the last two sentences].

Results in the treatment of cancer must be examined as closely as a grove of olive trees found on the planet Mars, otherwise unbridled enthusiasm for a new treatment may lead to disappointment when it is finally compared to an older, more established regimen. Thus the clinical research of the medical oncologist plods along – no wonder there are so many gray-haired doctors out there!