A Closer Look at the Zevalin Therapeutic Regimen

In 2002, the FDA approved Zevalin (ibritumomab tiuxetan) as a treatment for patients with relapsed or refractory, low-grade or follicular B-cell non-Hodgkin's lymphoma. At that time, Zevalin became the first conjugated antibody for the treatment of non-Hodgkin's lymphoma, and the first radioimmunotherapy agent for the treatment of NHL.

Then, in September, 2009 the FDA gave expanded approval to Zevalin for the treatment of patients with previously untreated follicular non-Hodgkin's Lymphoma (NHL) who achieve a partial or complete response to first-line chemotherapy.

How does it work?

Here's the Zevalin therapeutic regimen, as the patient can expect it to go (minus most of the biochemistry).

Treatment: Day 1

You begin by being pretreated with acetominephen and diphenhydramine (Tylenol and Benadryl). Then you receive an IV infusion of rituximab (this could take 4 hours), administered by your hematologist or oncologist.

Treatment: Day 7, 8, or 9

Similar to day 1, you begin by being pretreated with acetominephen and diphenhydramine (Tylenol and Benadryl). Then you receive another IV infusion of rituximab. Within 4 hours of this, you will be taken to your treatment facility's nuclear medicine or radiation oncology department.

There, you will be given your Y-90 Zevalin treatment (an IV injection lasting around 10 minutes).

Is it effective?

The Zevalin therapeutic regimen is an out-patient treatment program that lasts no longer than 10 days, requires two 4-hour infusions of rituximab and one 10-minute infusion of Zevalin.

According to a Phase-3 study involving 414 patients with follicular lymphoma, when the Zevalin therapeutic regimen is used as part of first-line treatment involving chemotherapy, Zevalin "significantly improved the median progression-free survival time from 18 months (control arm) to 38 months (ZEVALIN arm)." Click HERE for more details of this study and the efficacy of the Zevalin therapeutic regimen.

What is Y-90 Zevalin?

Y-90 Zevalin consists of a monoclonal antibody (Zevalin) combined with the radioisotope Y-90. Inside your body, the Zevalin seeks out and attaches itself to the CD20 antigen found on the surface of both malignant and normal B-cells. Meanwhile, the radioisotope Y-90 creates a type of radiation called beta emission, and these emissions are powerful enough to damage cancer cells (and possibly some healthy cells).

What is rituximab?

Rituximab (marketed as Rituxan) is a monoclonal antibody used to treat indolent and follicular B-cell Non-Hodgkin’s Lymphomas (NHL). It works by attaching itself to the CD20 antigen found on malignant and normal B-cells, which in turn activates the body’s immune system to attack and kill the cells.

What changes have been made to the Zevalin regimen?

In November of 2011, the US Food & Drug Administration removed the so-called bioscan requirement from the Zevalin regimen. Previously, on days 1 and 4, patients received an injection of indium-111 combined with Zevalin (known as In-111 Zevalin) for screening purposes. This is no longer a requirement, although it may still be ordered by your oncology team at their discretion.

Additional Sources:

• Zevalin on LymphomaInfo
• The National Cancer Institute's information page on Zevalin
• The manufacturer's information page for Rituxan (rituximab)
• The National Cancer Institute's information page on rituximab
• The Society of Nuclear Medicine's response to Zevalin's latest FDA approval