Radioimmunotherapy using the radioactive drug yttrium-90 (90Y) ibritumomab tiuxetan following chemotherapy with fludarabine and mitoxantrone is feasible, well tolerated, and effective for follicular non-Hodgkin’s lymphoma (NHL) patients. This was published on March 13, 2008 in The Lancet Oncology.
Follicular lymphoma is cancer of the lymphocytes of the follicle center B-lymphocytes. Approximately 30% of all newly diagnosed NHLs are follicular lymphomas, making it the most common type of lymphoma in the United States and Europe. Various trials have previously shown that the combination of a chemotherapy regiment with rituximab, a targeted B-cell lymphoma treatment that is not radioactive, will increase the instance of progression-free survival in comparison with the chemotherapy regimen alone. Similar to rituximab, 90Y-ibritumomab tiuxetan is a drug which is able to target B-cell lymphomas by attaching to specific surface proteins on the cells. However, once attached, the radioactive yttrium-90 attacks and kills the highly sensitive lymphoma cells as it emits β-radiation.
To discover the potential benefits of 90Y-ibritumombab tiuxetan over rituximab, Professor Pier Luigi Zinzani, Institute of Haematology and Oncology “L & A Seragnoli”, University of Bologna, Italy, and colleagues studied 61 patients in 13 different institutions in Italy. All patients were administered six cycles of oral fludarabine and intraveouns mitoxantrone. 57 of these were deemed eligible for subsequent treatment with 90Y-ibritumomab tiuxetan, 43 of these with a complete response (CR) to the therapy and 14 with partial responses (PR).
12 of the 14 PRs reached complete response in the latter part of the trial after the combined treatment regimen. With a followup of 30 months median, the three year progression free survival was estimated at 76%, with a three year overall survival of 100%. 36 of the 57 total patients showed grade 3 or 4 haemotological toxic effects.
The authors indicate that this study shows promise for combination therapies using 90Y-ibritumomab tiuxetan. They conclude: “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 NHL. 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 NHL.”
Fludarabine and mitoxantrone followed by yttrium-90 ibritumomab tiuxetan in previously untreated patients with follicular non-Hodgkin lymphoma trial: a phase II non-randomised trial (FLUMIZ)
Pier Luigi Zinzani, Monica Tani, Alessandro Pulsoni, Marco Gobbi, Alessio Perotti, Stefano De Luca, Alberto Fabbri, Alfonso Zaccaria, Maria Teresa Voso, Pierpaolo Fattori, Luciano Guardigni, Sonia Ronconi, Maria Giuseppina Cabras, Luigi Rigacci, Amalia De Renzo, Enrica Marchi, Vittorio Stefoni, Mariapaola Fina, Cinzia Pellegrini, Gerardo Musuraca, Enrico Derenzini, Stefano Pileri, Stefano Fanti, Pier Paolo Piccaluga, Michele Baccarani
The Lancet Online March 13, 2008
DOI:10.1016/S1470-2045(08)70039-1
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Written by Anna Sophia McKenney