About the chemotherapy agent Bendamustine


Bendamustine hydrochloride is an alkylating agent recently approved by the FDA for treatment of Chronic Lymphocytic Leukemia (CLL). The FDA approved bendamustine (trade name Treanda) based on a randomized, controlled, multicenter trial using either bendamustine or chorambucil, another alkylating agent, as initial treatment for CLL. This trial showed good results were obtained with bendamustine. A more recent study further found that CLL patients treated with bendamustine as a first-line therapy did better than those treated with the older drug chlorambucil.

In Oct 2008, the FDA extended its approval for bendamustine to treat indolent B-cell non-Hodgkin's lymphoma (NHL). Indolent NHL strikes about 30,000 people in the US every year. The FDA action was for people whose NHL had not responded to treatment with rituximab (Rituxan).

Bendamustine was developed in East Germany during the 1960’s. It has been used there to treat more than 20,000 cancer patients, including those with multiple myeloma, non-Hodgkin’s lymphoma and solid cancers. Studies are ongoing in Germany, the United States, and other countries to see how well bendamustine works for cancers other than CLL.

Bendamustine is a "bifunctional mechlorethamine derivative." The drug and its derivatives break down into alkyl groups. The alkyl groups bond with substances inside of tumor cells. This eventually leads to cell death. (Alkylating agents are one of the oldest types of chemotherapy medicine.) The exact mechanism by which bendamustine kills tumor cells is not known. In addition to being an alkylating agent, it also has similarities with other cancer treatment drugs, nucleoside analogs and purine analogs. Indeed, it has structural similarities to other alkylating agents and antimetabolites used in cancer treatment, but one good thing is that patients who develop resistance to those other drugs (e.g. carboplatin, etc.) don't automatically become resistant to bendamustine.

Bendamustine has also been investigated for use as a salvage therapy in advanced breast cancer. Its low toxicity and clinical trial results that show increases in patient survival times have drawn the attention of cancer researchers, who suggest that a weekly administration of the drug may be beneficial for breast cancer that has already been treated with taxol or antibiotics.

This medication differs from many other chemotherapy agents in that it can be given infrequently. Indeed, a recent study suggested that once-every-three weeks administration of bendamustine can be effective. The medication also promises to be an advance in the quest to develop personalized chemotherapy based on individual patient characteristics, although that still remains a ways off.