Treanda Likely Big Winner in Indolent NHL

Implications: Treanda (Bendamustine) combines the activity of a purine analog and alkylating agent, two of the most potent cytotoxic classes in therapy of indolent NHL.  Older data from Europe as well as more recent clinical trials have confirmed the excellent activity of Treanda in indolent NHL and CLL.  Both of these diseases are essentially incurable and patients will receive many treatments over the course of their disease.  Treanda's efficacy and toxicity profile as well as the ability to combine this agent effectively with Rituxan will make this a popular second line therapy for patients with indolent NHL. 

Analysis: Despite the success of Rituxan, both as a single agent and in combination with chemotherapy for the treatment of NHL, patients with indolent NHL are not cured of their disease.  Published data on Treanda, both as a single agent and in combination with Rituximab indicate a high response rate and tolerable toxicity.  In addition, Treanda is active in CLL and likely to be approved for that indication.  To date, Cephalon has done a good job of creating "buzz" about this agent and I believe it will rapidly become a popular therapy in the treatment of indolent NHL, capturing significant market share in a short amount of time.  Whether the drug is as novel as claimed is the source of some debate, but there is no doubt that it is active in the treatment of indolent NHL.