Zevalin Safe and Effective in High-Risk Elderly Patients with Diffuse Large B-Cell Lymphoma
Radioimmunotherapy treatment with Zevalin® (ibritumomab tiuxetan) is safe and effective in high-risk elderly patients with diffuse large B-cell lymphoma, according to the results of a study published in Clinical Cancer Research
Non-Hodgkin’s lymphoma (NHL) refers to a group of cancers that originate in different cells of the immune system. Diffuse large B-cell NHL is a common type of NHL that affects immune cells called B-cells; it is considered an aggressive type of NHL.
Standard treatment for DLBCL typically includes R-CHOP, which refers to treatment with the monoclonal antibody Rituxan® (rituxamab) plus cyclophosphamide/Adriamycin/vincristine/prednisone (CHOP). Although this regimen has led to improved outcomes, there is a group of poor-risk patients who need an alternative treatment strategy.
Zevalin is a type of radioimmunotherapy treatment (RIT) that combines the monoclonal antibody Rituxan with Zevalin, which is comprised of an anti-CD20 monoclonal antibody and Yttrium-90, a radioisotope that delivers the radiation. When injected into the body, Zevalin attaches to a protein (CD20) found only on the surface of B-lymphcytes, such as cancerous B-cells found in many forms of non-Hodgkin’s lymphoma. The radioactivity that is spontaneously emitted targets the B-cell and destroys it. This approach protects healthy tissue.
Zevalin has been shown to be a highly effective treatment-and has the added benefit of being administered over a single short period of time. Zevalin is administered on an outpatient basis and the total duration of therapy is less than 10 days. Zevalin offers active patients the opportunity to spend less time undergoing treatment than more conventional chemotherapy.
Between 2006 and 2008, researchers treated 55 high-risk elderly (over age 60) patients with untreated DLBCL with a short course of chemotherapy consisting of four cycles of R-CHOP followed by Zevalin 6 to 10 weeks later. Of the 55 patients treated with R-CHOP, 48 underwent subsequent Zevalin treatment. The overall response rate to the entire treatment regimen was 80 percent, including 73 percent complete remissions and 7 percent partial remissions. Eight of the 16 patients who achived less than a complete response with R-CHOP improved their remission status after Zevalin.
After a median follow-up of 18 months, the two-year progression-free survival was estimated to be 85 percent, with a two-year overall survival of 86 percent.
The researchers concluded that Zevalin could play a “pivotal role” in elderly DLBCL patients. The treatment was safe and effective and could reduce the overall number of chemotherapy courses necessary in this subset of high-risk DLBCL patients.
Zinzani PL, Rossi G, Franceschetti S, et al. Phase II trial of short-course R-chop followed by 90 Y-Ibritumomab tiuxetan in previously untreated high-risk elderly diffuse large B-cell lymphoma patients. Clinical Cancer Research. 2010; 16(15): 3998-4004.
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