Rituximab -- For Pain

What is rituximab?

Rituximab belongs to a new group of cancer drugs known as monoclonal antibodies. It is used to treat the commonest type of low-grade non-Hodgkin's lymphoma (B-cell). CancerBACUP has a booklet called Understanding non-Hodgkin's lymphomas which we would be happy to send you. Rituximab is also sometimes used to treat other types of lymphoma. It is usually given to people whose cancer has come back after chemotherapy. At the moment trials are looking at rituximab's effects when it is given in combination with chemotherapy.

What is a monoclonal antibody?

Monoclonal antibodies are used to try and destroy some types of cancer cells while causing little harm to normal cells. They are designed to recognise certain proteins that are found on the surface of some cancer cells. The monoclonal antibody recognises the protein and locks onto it (like a key in a lock). This may then trigger the body's immune system to attack the cancer cells and can sometimes cause the cells to destroy themselves.

Rituximab locks onto a protein called CD20 which is found on the surface of one of the main types of normal white blood cells (B-cell lymphocytes). It is also present on the surface of most of the abnormal B-cell lymphocytes which cause certain types of low-grade non-Hodgkin's lymphoma. Rituximab acts by attacking both malignant and normal B-cell lymphocytes. However, the body quickly replaces any normal white blood cells which are damaged, so the risk of side effects from this is very small.

What it looks like

Rituximab is a clear fluid after being diluted.

How it is given

Rituximab is given as a drip (infusion) into the vein through a fine tube inserted into the vein (cannula). Some people can have an allergic reaction to rituximab (see Possible side effects) and to reduce the risk of this the first dose is given slowly over a number of hours. You will be given some drugs before the treatment is given to prevent this. If you do have a reaction the infusion can be stopped and started again when the symptoms are over. You may need to stay in hospital overnight for the first treatment so that you can be monitored. After that it can usually be given in the outpatients department and over a shorter period of time. Rituximab is usually given weekly over a period of four weeks. The treatment may be repeated later if needed.

Possible side effects

The side effects of rituximab are generally mild and some of these can be reduced with medication. Side effects can begin during the first dose of the drug and continue for a few hours afterwards, but are usually milder with following doses. The most common side effects are:

Flu-like symptoms. This can include fever and chills, weakness, muscle aches, tiredness, dizziness and headache. These can occur while the drug is being given, but do not usually last long.

Low blood pressure. This may happen during the infusion so your blood pressure will be regularly checked. People who normally take drugs to lower their blood pressure may be advised by the doctor to take these at least 12 hours before rituximab is given.

Feelings of sickness (nausea) and occasional vomiting. There are now very effective anti-sickness drugs to prevent or substantially reduce this. If the sickness is not controlled, or continues, tell your doctor. They can prescribe other anti-sickness drugs which may be more effective.

Mild pain in parts of the body where the cancer has spread. Painkillers can be given to relieve this.

Allergic reactions. It is not unusual to have a slight allergic reaction to rituximab. Signs of this include skin rashes and itching, a feeling of swelling in the tongue or throat, irritation of the nasal passages, wheezing, a cough and shortness of breath. You will be monitored closely during your treatment but do tell your nurse or doctor if you have any of these symptoms. To reduce the chance of developing an allergic reaction certain drugs (antihistamines) can be given before the infusion. The infusion can also be slowed down or stopped until the reaction is over.

Flushing. You may experience a sudden warmth in your face and some redness of the face. This can happen for a short period of time during the infusion.

Additional information

Rituximab may worsen heart problems in people who already have these. For this reason it is used with caution in anyone with a history of heart disease.

For more information call CancerBACUP's Cancer Support Service on 020 7613 2121 or Freephone 0808 800 1234 to speak to a cancer specialist nurse. Lines are open Monday-Friday, 9am-7pm.

This information has been compiled by CancerBACUP's Support Service.

We thank the patients and specialist advisers who have helped with the production of this factsheet.

  This factsheet has been compiled using information from a number of reliable sources including Martindale, The Data Sheet Compendium and the British National Formulary. Each CancerBACUP factsheet is regularly reviewed and updated by cancer doctors, pharmacists, specialist nurses, other relevant health professionals and people with cancer.