Bendamustine for indolent non-Hodgkin lymphoma in the front-line or relapsed setting: a review of pharmacokinetics and clinical trial outcomes

Abstract

Bendamustine is an agent with mostly alkylating properties, which acts on dividing cells through multiple pathways. As an agent with little cross-resistance with other chemotherapeutic agents, bendamustine has received approval for second-line use in relapsed/refractory indolent lymphomas. A growing body of data showing good efficacy and acceptable tolerability of bendamustine in first-line use has led to recognition that this agent has an important role in this setting. This article outlines the pharmacology and clinical studies supporting the use of bendamustine and discusses the role of this agent in the first- and second-line treatment of indolent lymphomas.

Keywords::

• bendamustine
• follicular lymphoma
• indolent
• mantle cell lymphoma
• non-Hodgkin lymphoma

Financial & competing interests disclosure

R van der Jagt has received research support and honoraria from Cephalon, Lundbeck, Celgene, Roche, Novartis and Teva Pharmaceuticals. Mundipharma International Limited and Teva Pharmaceutical Industries (Frazer, PA) each provided a medical accuracy review of the final draft. The author was not compensated and retained full editorial control over the content of the paper. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Editorial assistance was provided by L Kanan of Anthemis Consulting Ltd., supported financially by an educational grant from Mundipharma International Limited, who had no input into the choice of author or any editorial input into the article.

Key issues

• • Bendamustine is an agent with unique alkylating properties, which acts on dividing cells through multiple pathways and shows only a low level or absence of cross-resistance with other alkylating agents.

• • Clinical trials have demonstrated that treatment with bendamustine – as a single agent or in combination with other drugs – results in high levels of response and good PFS in patients with relapsed or refractory indolent NHL or MCL. Progression-free survival (PFS) in indolent lymphoma has now been demonstrated to be significantly better with BR when compared to other standard regimens.

• • In the first-line setting, bendamustine in combination with rituximab provides similar if not better response rates compared with the standard chemotherapy regimens of R-CHOP or R-CVP, but with a distinct toxicity profile.

• • Overall, good efficacy and tolerability data suggest that bendamustine in combination with rituximab is a very attractive first- or second-line option for patients with low-grade NHL.

Notes