Rituximab is used to treat non-Hodgkin lymphoma (NHL) and chronic lymphocytic leukemia (CLL).
WHAT IS RITUXIMAB?
Rituximab belongs to a group of cancer drugs known as monoclonal antibodies. Monoclonal antibodies are sometimes called targeted therapies.
HOW DOES RITUXIMAB WORK?
Rituximab locks on to a protein called CD20, which is found on the surface of white blood cells called B-lymphocytes (B-cells). CD20 is found on normal B-cells and in most abnormal (malignant) B-cells that occur in many types of NHL. CD20 is also found in some of the abnormal B-cells that occur in CLL.
Rituximab destroys both abnormal and normal B-cells by triggering the body's immune system to attack the cells. However, the body can replace damaged B-cells, so their numbers recover once the treatment is over.
WHEN IS RITUXIMAB USED?
Rituximab is used to treat several types of CD20-positive NHL (NHL in which CD20 is found on the surface of the cancer cells). It can also be used to treat CLL. It is often given in combination with chemotherapy, though it can also be given as a stand-alone treatment.
Rituximab can also be used to treat other conditions that are not cancer.
WHAT DOES RITUXIMAB LOOK LIKE?
Rituximab is a colorless liquid.
HOW IS RITUXIMAB ADMINISTERED?
Rituximab is given as a drip into a vein (intravenous infusion). It can be given alone or with other chemotherapy drugs.
Some people have an allergic reaction to rituximab. Reactions are most common when the first dose is given, so to reduce the risk of a reaction happening, the first infusion is given slowly over a number of hours. You will be given drugs before the treatment begins to help prevent or reduce any reaction.
If you develop a reaction, the infusion can be stopped and then started again once the symptoms have gone away. You may need to stay in the hospital on the first night after the treatment so you can be monitored. After the first treatment, rituximab can normally be given on an outpatient basis and the infusion time is lowered.
When used alone, rituximab is commonly given weekly over a period of four weeks. The treatment can be given once again if necessary.
If used as a maintenance treatment after successful chemotherapy, rituximab is often given every two months over a maximum of two years.
When given with chemotherapy, rituximab is often given on the first day each chemotherapy treatment cycle.
POSSIBLE SIDE EFFECTS
Each person reacts differently to cancer treatment. Some people have very few side effects, while others may develop more. The side effects described here will not affect everyone who is treated with the drug.
We outline the most commonly side effects, though we have left out the rarer ones. If you notice you develop any side effects that are not listed here, talk to your doctor or specialist nurse.
The side effects of panitumumab are normally mild, and some can be relieved with drugs. These side effects fall into two groups:
- Infusion-related reactions, which can occur during the infusion or over a maximum of about 24 hours thereafter.
- Other side effects that can happen days or even weeks later.
These are uncommon and affect fewer than 5 out of every 100 given the infusion. If reactions do happen, they are normally mild, though in rare cases they can be severe. You can take drugs before the infusion to reduce the likelihood of having a reaction. If you have a reaction, the drip is usually lowered or stopped until you feel better. Future infusions will be given at a slower pace.
You will be closely monitored during your treatment, though you should tell your nurse or doctor if you feel unwell or have any of the following symptoms:
- flu-like symptoms, such as feeling flushed or having a fever, shivering, or nausea
- red, warm, and itchy bumps on the skin (such as urticaria)
- a feeling of swelling in the lips, tongue, or throat
- breathlessness, wheezing, cough, or sudden difficulty breathing
- back or stomach pain
- chest pain or pressure in your chest.
Sometimes, a reaction related to the infusion can happen a couple of hours after the treatment. If you develop these symptoms or feel unwell after you get home, get in touch with your hospital immediately for advice.
LOW BLOOD PRESSURE
Some people's blood pressure decreases during the infusion. Your blood pressure will be checked regularly. If you normally take blood-pressure drugs, tell your doctor about this. They can tell you about when it is best to take these drugs before rituximab is given.
During the infusion, some people feel slight pain in the parts of their body where their cancer is located. Pain killers may help relieve this pain.
Later side effects
RISK OF INFECTION
Pazopanib can reduce your number of white blood cells, which help fight off infection. White blood cells are produced by bone marrow. If your white blood cell count is low, you will be more prone to infection. A low number of white blood cells is called neutropenia.
The number of white blood cells normally increases gradually, returning to normal before your next chemotherapy treatment. You will have a blood test before the next treatment to check your white blood cells. It may sometimes be necessary to delay the treatment if your blood count shows that you still have a low number of white blood cells.
Contact your doctor or your hospital immediately if:
- your temperature rises above 38 ° C
- you suddenly feel unwell, even if your temperature is normal.
BRUISING AND BLEEDING
Pazopanib can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bleeding or bruising, such as nosebleeds, bleeding gums, blood spots, or skin rashes. You may have a platelet transfusion if your platelet count is low.
ANEMIA (LOW RED BLOOD CELLS)
Pazopanib can reduce the number of red blood cells, which transport oxygen throughout the body. A low number of red blood cells is called anemia. This may make you feel tired and short of breath. Tell your doctor or nurse if you have these symptoms. You may need a blood transfusion if the number of red blood cells in your blood is too low.
Your doctor can prescribe very effective antiemetic drugs, which can prevent or substantially reduce your nausea or vomiting. If your nausea remains uncontrolled or continues, tell your doctor, as they can prescribe other drugs that could be more effective.
Some antiemetic drugs can cause constipation. Tell your doctor or nurse if this is a problem.
Rituximab can worsen heart problems in people with existing heart conditions. For this reason, the drug is used with great caution in all patients with heart disease. Some tests may be run to see how well your heart is working.
ADDITIONAL INFORMATION ON RITUXIMAB
Some drugs, including those bought over the counter in a store or pharmacy, may be harmful to you while you are taking rituximab. Tell your doctor if you are taking any medicines, including over-the-counter medications, complementary therapies, and herbal medicines.
This treatment may affect your ability to conceive. It is important that you talk to your doctor before beginning treatment.
Little is known about the effects of rituximab on developing babies. Therefore, it is not recommendable to become pregnant while taking this drug.
It is unknown whether rituximab is present in semen or vaginal fluid. In order to protect your partner, it is safest to avoid having sex or use a barrier contraceptive device for about 48 hours after the chemotherapy.
There is a potential risk that rituximab may be present in breast milk, and therefore women are recommended not to breast feed during the treatment and for a few months afterward.
If you are admitted to the hospital for any reason not related to cancer, it is important that you tell your doctors and nurses caring for you that you are receiving treatment with rituximab.