Could This Immunotherapy Be Right for You?
- Rituximab (Rituxan) is a treatment that helps your immune system target lymphoma cells
- It’s approved to treat certain B-cell lymphomas
- Rituxan is most often given as an infusion that you get into a vein, but it can also be given as an injection under the skin
- Possible side effects include fever, chills, itching, rash, and infection
Our immune system is designed to fight off harmful invaders, and that includes cancer. It uses proteins called antibodies to find and stick to the foreign cells, targeting them for destruction. But sometimes the immune system needs a little help finding and fighting lymphoma, which for some people can come in the form of immunotherapy drugs.
Rituximab (Rituxan) was the very first immunotherapy drug approved to treat some forms of non-Hodgkin lymphoma. “Rituximab is the immunotherapy that has been approved the longest and we have the most experience with for lymphoma,” Dr. Elise Chong, medical oncologist at Penn Medicine, tells SurvivorNet.
Rituxan is a type of immunotherapy drug called a monoclonal antibody. “What that means is it’s a manufactured antibody,” Dr. Chong says. “Just like our body produces antibodies, we’re able to manufacture antibodies in the lab.”
It’s designed to seek out and stick to another type of protein called an antigen on the surface of infection-fighting white blood cells, called B cells. The antigen in this case is CD20. Rituxan will only work on cancerous B cells with the CD20 antigen on their surface. Most T-cell lymphomas don’t contain this protein, which is why this treatment isn’t effective against them.
“CD20 needs to be expressed on the surface of the lymphoma cell because you want that antibody to target something that’s specific to your lymphoma,” Dr. Chong says.
Rituxan, either alone or in combination with chemotherapy, is approved for people with several types of B-cell non-Hodgkin lymphoma, such as:
- Follicular lymphoma
- Diffuse large B-cell lymphoma
- Chronic lymphocytic leukemia
- Marginal zone lymphoma
- Mantle cell lymphoma
How You’ll Get Rituxan
You may get Rituxan as the very first treatment for non-Hodgkin lymphoma, or after you’ve already been on chemotherapy. Your doctor can prescribe this drug on its own (which is called monotherapy), or together with chemotherapy (which doctors call chemoimmunotherapy).
Rituxan is often given as an infusion through a vein. The dose you receive depends on the type of lymphoma you have.
The first infusion generally takes a few hours, but later infusions only take about an hour. Usually you’ll get Rituxan at an infusion center, during the same session as your chemotherapy. How you get this drug “really depends on the type of lymphoma you have, where your lymphoma is located, and what your physician thinks is the best approach for you,” Dr. Chong says.
Rituxan is now also approved to be given as an injection under the skin (subcutaneous injection) for many types of B-cell lymphoma. This may allow for faster delivery of the drug, and minimize the infusion-related reactions. However, different people prefer different modes of treatment delivery. Also, the subcutaneous form isn’t approved for all types of B-cell lymphomas.
What Are the Side Effects?
Most people tolerate Rituxan very well, Dr. Chong tells SurvivorNet. The most common side effects are what doctors call “infusion reactions,” because they start within the first 24 hours after you get the infusion. Watch for symptoms like these:
- A feeling of cold and shivering, called rigors
- Swelling under the skin
- Fast heart rate
- Mild shortness of breath
Because healthy B cells also have the CD20 antigen on their surface, Rituxan can kill some of them, as well. A loss of these immune cells can impair your body’s ability to fight infections. Once you’ve finished treatment, your body will replenish these cells, but in the meantime, you’ll need to take extra precautions, such as staying away from large groups of people or wearing a mask, to avoid getting sick.
Occasionally, people have more severe side effects, such as low blood pressure or trouble breathing, which is why your chemotherapy nurses will carefully monitor you while you’re getting the infusion.
“It’s really important if people are receiving a rituximab infusion that they tell their physician or the nurse who’s supervising right away if they are having any side effects so that we can stop the infusion or modify the infusion,” Dr. Chong says.