Treatment Name: Rituximab + Hyaluronidase (Rituxan Hycela®)
Rituximab + Hyaluronidase (Rituxan Hycela®) is an Immunotherapy Regimen for Lymphoma, B-cell
How does subcutaneous rituximab hyaluronidase (Rituxan Hycela®) work?
- Rituximab is an FDA approved antibody that is designed to target and bind to a protein on the surface of cancerous b-cells. When rituximab binds to this protein, it helps your immune system destroy the cancer cell
- Hyaluronidase is a naturally occurring protein in the body that increases the ability of the tissue under the skin to absorb fluid. Hyaluronidase helps absorption of rituximab when given together as an injection under the skin
Goals of therapy:
Cancer patients with B-cell Lymphoma that have symptoms such as fevers, night sweats, and weight loss may benefit from Rituximab Hyaluronidase (subcutaneous Rituxan Hycela). It is a blood cancer treatment injected alone or prescribed with chemotherapy. Rituximab hyaluronidase is often given with the goal of cure, but may be given as maintenance therapy to keep lymphoma in remission.
- Rituximab hyaluronidase is injected over 5 to 7 minutes subcutaneously (SC or SubQ or SQ) into the abdomen on Day 1 of each Cycle
- Injection times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications with acetaminophen (Tylenol®), an antihistamine (Benadryl®), and intravenous (I.V.) fluids, such as hydration, may add more time
Before getting rituximab hyaluronidase by subcutaneous administration, cancer patients receiving this must get at least one full infusion of intravenous Rituxan due to the risk of infusion reactions with the first dose. If no reactions occur, subcutaneous rituximab hyaluronidase may be substituted for I.V. rituximab as a way to reduce the time patients need to spend in an outpatient infusion center. On occasion, it may be given in the hospital if someone is too sick. Patients are observed for side effects for at least 15 minutes after each injection.
How often rituximab hyaluronidase is given is dependent upon the schedule of your chemotherapy regimen.
Click here for the common rituximab hyaluronidase (Rituxan Hycela®) starting doses.
Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability.
In clinical studies, the most commonly reported side effects of rituximab hyaluronidase are shown here. Side effects sometimes have percentage ranges [example: 14 – 32%] because they differed between clinical studies. Additionally, side effects reported with rituximab hyaluronidase depend upon which chemotherapy agents it was combined with:
- Low white blood cells [neutropenia], (14 - 32%)
- Nausea, (9 - 32%)
- Constipation, (5 - 25%)
- Cough, (5 - 23%)
- Low red blood cells [anemia], (10 - 21%)
- Fatigue, (9 - 20%)
- Diarrhea, (5 - 18%)
- Weakness, (17%)
- Injection site reactions [redness, itching, rash, mild pain], (5 - 16%)
- Tingling or numbness in fingers or toes, (5 - 16%)
- Sinus infection, (10 - 15%)
- Fever, (6 - 15%)
- Stomach pain, (14%)
- Hair loss, (13 - 14%)
- Vomiting, (3 - 14%)
- Headache, (13%)
- Joint pain, (13%)
- Neutropenic fever, (8 - 13%)
- Shortness of breath, (11%)
- Pneumonia, (5 - 11%)
- Itching, (10%)
- Bone pain, (10%)
- Rash, (10%)
- Pain in arms or legs, (10%)
- Sore throat. (9%)
Note: in clinical trials, rituximab hyaluronidase was investigated in combination with chemotherapy (R-CHOP or R-CVP or R-Bendamustine) therefore it is unknown if the reported side effect frequencies are due to combination with chemotherapy or single agent rituximab hyaluronidase. The risk of neutropenic fever may be greater when subcutaneous rituximab is given as compared to I.V. rituximab.
How often is monitoring needed?
Labs (blood tests) may be checked before each treatment and in-between treatments at the discretion of your doctor. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), uric acid, phosphorous, Lactate Dehydrogenase (LDH), plus any others your doctor may order. Hepatitis B screening and Human Immunodeficiency Virus (HIV) screening may also be done before starting treatment.
How often is imaging needed?
Imaging may be checked before treatment then approximately after every two or three cycles. Imaging may include: computerized tomography (CT) scan or positron emission tomography (PET) scans.
How might blood test results/imaging affect treatment options?
Depending upon the results, your doctor may advise to continue rituximab hyaluronidase as planned, pause treatment, change the dose, or switch to an alternative (different) therapy.
- Premedications such as diphenhydramine (Benadryl®), acetaminophen (Tylenol®), and hydrocortisone (Solu-Cortef®) may be given before rituximab hyaluronidase to help prevent infusion-related side effects. Oral premedications were given in the clinical studies
- Due to the amount of liquid that is injected, the entire dose of rituximab hyaluronidase must be injected slowly over at least 5 to 7 minutes. Patients will be watched closely for at least 15 minutes after the injections for any reactions
- Patients and/or caregivers should have a plan in place if a reaction to the injection happens at home. Talk to your doctor about what you should do to prepare
- Rituximab hyaluronidase should ONLY be injected into the abdomen. No other injection site on the body should be used
- Do NOT combine any other subcutaneously administered medications, such as insulin or other medications for diabetes, in the same injection site as rituximab hyaluronidase. This will help avoid cutaneous reactions (skin reactions)
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for b-cell lymphoma. Ask your doctor or healthcare professional if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Rituximab + Hyaluronidase (Rituxan Hycela®), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Rituximab + Hyaluronidase (Rituxan Hycela®). Depending upon your income, they may be able to help cover the cost of:
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Rituximab + Hyaluronidase (Rituxan Hycela®) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.
What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.
Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.
Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.
Learn more about pursuing emotional wellness while receiving treatment with Rituximab + Hyaluronidase (Rituxan Hycela®)