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Biotech / Medical : CLTR COULTER PHARMACEUTICAL
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To: Gordon James who wrote (243)8/21/1999 2:05:00 PM
From: Bob L  Read Replies (1) of 666
 
Thanks for the review of what little is available on combination use of fludarabine and monoclonals. One small point. In regard to the problems with rituxan and fludarabine, you said "it looked like they got good results with the lower dose anyway". It looks to me like they reduced the dose for future study and the very preliminary encouraging results were for the old higher dose. Medscape had this summary:

"A total of 9 patients have completed at least three courses of therapy. Although the data set is too preliminary for any real conclusion to be drawn, 1 CR was seen and 8 PRs. However, unexpectedly severe hematologic toxicity has been seen, necessitating a 40% reduction of the fludarabine dose (25 mg/m2 x 3 days) in future protocols. Because of severe neutropenia, two chemotherapy naïve patients were removed from study. Further, 8 of 10 patients experienced grade 3 or 4 neutropenia, requiring growth factor support. Two patients were hospitalized for neutropenic fever, and two patients developed grade 3 thrombocytopenia, which required platelet transfusions. This study demonstrates quite nicely that unexpected toxicity can occur when licensed drugs are used in combination. Further results are awaited."

In any event, I will modify my question to "why Bexxar+fludarabine instead of Rituxan+(CHOP or fludarabine) for first-line treatment?" Obviously this can't be answered now, but it will be very interesting to see how this unfolds.

Thanks again for your post.
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