Plosker Greg L, Carter Natalie J
Wolters Kluwer Health, Adis, Auckland, New Zealand.
Drugs. 2008;68(18):2645-60. doi: 10.2165/0003495-200868180-00009.
Bendamustine (Treanda, Ribomustin) is a bifunctional alkylating agent that also has potential antimetabolite properties, and only partial cross-resistance occurs between bendamustine and other alkylators. In patients with indolent non-Hodgkin lymphoma (NHL), bendamustine monotherapy achieved high objective response rates in those with rituximab-refractory disease in a pivotal noncomparative trial and a similarly designed smaller phase II study. Many of these heavily treated patients were also refractory to standard chemotherapy regimens. Several phase II trials demonstrated good response rates with single-agent bendamustine, or bendamustine in combination with rituximab, in patients with indolent NHL whose disease relapsed after (or was refractory to) chemotherapy. Phase III studies comparing combination regimens as first-line therapy in patients with indolent NHL showed no significant differences in response rates between bendamustine-containing regimens and standard regimens included in treatment guidelines. Bendamustine has been generally well tolerated in clinical trials and has a low propensity to induce alopecia. Results of ongoing trials will help to clarify the optimal role of bendamustine in indolent NHL. Available data indicate that it may be a particularly useful treatment option as monotherapy in patients with indolent NHL whose disease progressed during or following rituximab-based therapy, many of whom are also refractory to standard chemotherapy regimens.
苯达莫司汀（Treanda、Ribomustin）是一种具有潜在抗代谢特性的双功能烷化剂，且苯达莫司汀与其他烷化剂之间仅存在部分交叉耐药性。在惰性非霍奇金淋巴瘤（NHL）患者中，在一项关键的非对照试验以及一项设计类似的小型II期研究中，苯达莫司汀单药治疗在利妥昔单抗难治性疾病患者中取得了较高的客观缓解率。这些接受过大量治疗的患者中，许多人对标准化疗方案也具有耐药性。多项II期试验表明，对于化疗后复发（或耐药）的惰性NHL患者，单药苯达莫司汀或苯达莫司汀联合利妥昔单抗治疗具有良好的缓解率。在惰性NHL患者中比较联合方案作为一线治疗的III期研究显示，含苯达莫司汀方案与治疗指南中纳入的标准方案之间的缓解率无显著差异。在临床试验中，苯达莫司汀总体耐受性良好，诱导脱发的倾向较低。正在进行的试验结果将有助于明确苯达莫司汀在惰性NHL中的最佳作用。现有数据表明，对于在基于利妥昔单抗的治疗期间或之后疾病进展的惰性NHL患者，尤其是其中许多对标准化疗方案也耐药的患者，苯达莫司汀作为单药治疗可能是一种特别有用的治疗选择。
