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Your doctor has recommended a medication called MabThera as treatment for your Non Hodgkins Lymphoma (NHL). This information sheet provides a brief introduction to MabThera and explains the common side effects you may experience.

This does not mean you will definitely get them. It is also possible you may experience a side effect not mentioned here. MabThera may be given in conjunction with chemotherapy so you should also refer to the specific information and advice sheet relating to these other drugs.

What is Mabhtera?  It is not chemotherapy and it is not a hormone therapy.  It is called a monoclonal antibody (Mab) and is one of the novel new cancer therapies which utilise the natural immune system (Immunotherapy). Cancers, grow mainly outside the control of the bodies normal regulatory systems (what is cancer).  Despite this they are sufficiently similar to the own bodies cells to escape the normal bodies defence mechanism against "foreign" attack, as a result they are able to hide from the bodies immune system. There are, however, some differences between cancer and normal body cells. These differences can be detected with sensitive laboratory tests. In some types of NHL a protein is present on the cell surface (an antigen) called  CD20. Over expression (making too much) of CD20 reflects an abnormality in the DNA of the cell - a tiny piece of DNA has moved from one chromosome called number 14 to number 18. This is called a translocation(14;18). This moves a cancer producing gene (previously locked out of harms way) into a position which turns the normal lymphoid cell into a cancerous lymphoma cell. This oncogene called bcl-2 is responsible for "over expressing" CD20.  In some cases particularly the low grade follicular type of NHL there are hundreds more CD20 receptors on the cancer cells than the normal cells.

Technology now exists to make antibodies (the normal chemicals used by the immune system to detect and attack foreign particles in the body). These antibodies have been made to detect CD20 receptors. The antibody is therefore an anti-CD20 treatment called Rituximab or  its commercial name MabThera. MabThera is indicated as a single-agent treatment for relapsed or refractory indolent NHL, and received European approval in March 2002 for the treatment of aggressive NHL in combination with CHOP chemotherapy. In September 2004, MabThera was also given a licence for the first line treatment of Follicular NHL in combination with CVP (Cyclophosphamide, vincristine and prednisolone) chemotherapy. The drug is known as Rituxan in the United States, Japan and Canada, and as MabThera in the rest of the world. 

 

t-marker.jpg (101045 bytes)How does Mabhtera work? Research has shown that 95% of patients with low grade follicular lymphoma over express CD20. The higher grades of  NHL are the less likely it is to have CD20 receptors (classification of lymphomas). In any case, before treatment, this can be measured  on a sample of lymphoma  in the original biopsy ( a further biopsy is usually not required).  If the NHL does over express CD20  down the microscope it will stain  brightly compared  the normal cells (see left picture).  In these  patients it is then possible to give MabThera to attack the lymphoma cells which still remain in the body.   In the body the MabThera finds the cancer cells wherever they may be hiding and sticks to the CD20 receptor. It then enhances the tumour response in a number of ways:-

 

How is Mabhtera given? Techniques may vary but the most commonly used technique is as an infusion into a vein in the hand or arm through a small plastic tube called a cannula. The infusion rate may vary on how it is tolerated but on the first occasion it is at least 4-5 hours. This is usually given as a day case. The dose is calculated by the height & weight of the patient (then converted into surface area). The recommended dose is 375mg/meter squared once a week for 4 infusions if given as monotherapy and 8 if given with chemotherapy.  Occasionally, as with all protein based drugs it is possible to get an allergic reaction. The nurses will therefore be checking how you are feeling and measuring your breathing, pulse and blood pressure blood regularly. Sometimes, in response to mild reaction, it may have to be slowed down over several hours. Rarely if there allergic reaction is prominent it has to be stopped altogether. To avoid a mild reaction often paracetamol and an antihistamine (e.g. piriton) are given before the infusion.  

 

Are there any side effects? When given with chemotherapy the side effect normally relate to the chemotherapy. Mabthera is usually well tolerated. It has a major advantage over chemotherapy by not damaging the bone marrow. It does have some mild side effects of its own:-

Infusion related reaction:-

Other potential side effects:-


Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.



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