Dillman Robert O
Hoag Cancer Center, Hoag Hospital, Newport Beach, CA, USA.
Semin Oncol. 2003 Aug;30(4):434-47. doi: 10.1016/s0093-7754(03)00235-5.
The anti-CD20 chimeric monoclonal antibody has been a tremendous addition to the therapeutic armamentarium against low-grade lymphoma. In indolent lymphoma, rituximab as a single agent is associated with 50% to 60% objective response rates in the relapsed setting and 60% to 75% as front-line therapy. Chemotherapy plus rituximab combinations have been associated with response rates of 85% to 95% and randomized trials have confirmed a higher response rate for various chemotherapy plus rituximab combinations compared to the same chemotherapy alone. Concurrent chemotherapy with rituximab does not increase toxicity and appears superior to sequences of chemotherapy followed by rituximab. Repeated intermittent therapy is associated with higher response rates and longer duration of remission. When used alone, the activity of rituximab is probably due to a combination of complement-dependent cytotoxicity, antibody-dependent cell-mediated cytotoxicity, and regulatory effects that enhance apoptosis. Dosing could probably be optimized by monitoring serum levels of rituximab in individual patients, because of the tremendous variability in lymphoma tumor burden, rates of tumor proliferation, rates of CD20 antigen production and expression, and clearance of rituximab. Combinations of rituximab with other monoclonal antibodies are currently being tested.
抗CD20嵌合单克隆抗体已成为治疗低度淋巴瘤的有效武器。在惰性淋巴瘤中，利妥昔单抗单药治疗在复发患者中的客观缓解率为50%至60%，作为一线治疗的缓解率为60%至75%。化疗加利妥昔单抗联合治疗的缓解率为85%至95%，随机试验证实，与单纯化疗相比，各种化疗加利妥昔单抗联合治疗的缓解率更高。利妥昔单抗与化疗同时使用不会增加毒性，且似乎优于先化疗后用利妥昔单抗的序贯治疗。重复间歇治疗的缓解率更高，缓解持续时间更长。利妥昔单抗单独使用时的活性可能归因于补体依赖性细胞毒性、抗体依赖性细胞介导的细胞毒性以及增强细胞凋亡的调节作用的综合作用。由于淋巴瘤肿瘤负荷、肿瘤增殖率、CD20抗原产生和表达率以及利妥昔单抗清除率存在巨大差异，通过监测个体患者的利妥昔单抗血清水平可能可以优化给药方案。目前正在测试利妥昔单抗与其他单克隆抗体的联合应用。
