November 10, 2008

Addition of Zevalin® to Chemotherapy Effective for Follicular NHL


Addition of Zevalin® to Chemotherapy Effective for Follicular NHL

Administration of Zevalin® (Y-ibritumomab tiuxetan) immediately following initial chemotherapy for advanced follicular lymphoma improves progression-free survival for two years compared with chemotherapy alone. These results were recently published in the Journal of Clinical Oncology.

Non-Hodgkin®s lymphoma (NHL) is a form of cancer that begins in the cells of the lymph system. The lymph system includes the spleen, thymus, tonsils, bone marrow, lymph nodes, and circulating immune cells. The main cells in the lymph system are lymphocytes, of which there are two types: B and T-cells. Each of these cells has a specific function in helping the body to fight infection.

NHL is characterized by the excessive accumulation of atypical (cancerous) lymphocytes. These lymphocytes can crowd the lymph system and suppress the formation and function of other immune and blood cells. NHL is categorized by the type of lymphocyte it involves and by the rate at which the cancer grows. Follicular lymphoma tends to be slow-growing and is referred to as an indolent type of NHL. It is the most common type of NHL.

In an attempt to avoid the often debilitating side effects associated with chemotherapy and radiation®standard treatment for NHL®researchers have been investigating novel therapeutic strategies for NHL.

Radioimmunotherapy is a novel therapy that involves treatment with a radioactive substance linked to an antibody. The antibody attaches to cancer cells when injected into the body. By delivering the radiation directly to the cancer, a larger amount of normal tissue is spared from radiation and there are fewer side effects. Zevalin, a radioimmunotherapeutic agent, is an antibody with radioactive Yttrium 90 attached. The monoclonal antibody portion of the drug attaches to a protein (CD20) found only on the surface of B-lymphocytes, such as cancerous B-cells found in many forms of NHL. The radioactivity that is spontaneously emitted targets the B-cell and destroys it.

Results from several clinical trials have demonstrated Zevalin®s effectiveness in the treatment of NHL. However, physicians must refer patients to radiologists or a nuclear medicine specialist for treatment with Zevalin. There is speculation that the referral process may contribute to low use of Zevalin among patients who might derive great benefit from its effects.

Researchers from 77 medical centers recently conducted a Phase III trial (phase prior to FDA review) evaluating the use of Zevalin immediately following chemotherapy in follicular NHL. This trial included 414 patients who were initially treated with chemotherapy. Patients who achieved a partial or complete anticancer response to therapy were then treated with Zevalin or no further therapy (control arm).

  • Progression-free survival was over three years (36.5 months) for patients treated with Zevalin compared with only 13.3 months for those in the control arm.
  • Among patients who achieved a partial regression of their cancer following chemotherapy, progression-free survival was 29.3 months for those treated with Zevalin and only 6.2 months for those in the control arm.
  • 77% of patients who achieved a partial regression of their cancer following chemotherapy achieved a complete disappearance of their cancer following treatment with Zevalin.
  • No unexpected side effects occurred with Zevalin.

The researchers concluded that Zevalin immediately following chemotherapy improves progression-free survival by two years among patients with advanced follicular lymphoma. Patients with follicular lymphoma may wish to speak with their physician regarding their individual risks and benefits of treatment with Zevalin.

Reference: Morschhauser F, Radford J, Van Hoof A, et al. Phase III trial of consolidation therapy with yttrium-90®ibritumomab tiuxetan compared with no additional therapy after first remission in advanced follicular lymphoma. Journal of Clinical Oncology. 2008;26:5156-5164.

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Tags: Indolent/Low Grade Non-Hodgkin's Lymphoma, Uncategorized