Radioimmunotherapy with the radioactive drug Yttrium-90 ( 90Y ) Ibritumomab tiuxetan ( Zevalin ), following chemotherapy with Fludarabine ( Fludara ) and Mitoxantrone ( Novantrone ), is feasible, well tolerated, and effective in patients with follicular non-Hodgkin lymphoma ( NHL ).
Follicular lymphoma accounts for around 30% of all newly diagnosed non-Hodgkin lymphomas, and is the most common form of lymphoma in the USA and Europe. The findings of various trials have shown that combination of a chemotherapy regimen with Rituximab ( MabThera, Rituxan ), a non-radioactive targeted treatment for B-cell lymphomas, significantly increased progression-free-survival compared with the same chemotherapy regimen alone.
Researchers wanted to see if this benefits could be improved if, instead of Rituximab, 90Y-Ibritumomab tiuxetan was used, which, as with Rituximab, is able to target B-cell lymphomas by attaching to a surface protein on those cells. Once attached, radiation from the radioactive yttrium-90 attacks and kills these highly-radiation sensitive lymphoma cells.
Pier Luigi Zinzani, at University of Bologna, Italy, and colleagues did a study of 61 patients across 13 Italian institutions. All received six cycles of oral Fludarabine and intravenous Mitoxantrone; and 57 of these ( 43 with complete response and 14 with partial response ) were deemed eligible for subsequent 90Y-Ibritumomab tiuxetan. Then of the 14 partial reponse patients, 12 achieved complete response after 90Y-Ibritumombab tiuxetan treatment; thus overall 55 of the 57 patients achieved complete response after the combined treatment regimen.
Further, with a median follow-up of 30 months, 3-year progression-free survival was estimated at 76%, and 3-year overall survival 100%. 36 of 57 patients had grade 3 or 4 haematological toxic effects.
According to Authors, this study has established the feasibility, tolerability, and efficacy of sequential treatment with six cycles of Fludarabine and Mitoxantrone chemotherapy followed by 90Y-Ibritumombab tiuxetan as a front-line treatment for untreated patients with follicular non-Hodgkin lymphoma. In particular, the data represent the first evidence of a role of 90Y-Ibritumombab tiuxetan after a Fludarabine-containing regimen in the treatment of follicular non-Hodgkin lymphoma.
Source: Lancet Oncology, 2008