Growing monoclonal antibodies in the lab. Photo by Linda Bartlett,
NCI
Zevalin Patient Resources
Zevalin® (ibritumomab tiuxetan) is a form of radioimmunotherapy (a radiolabeled monoclonal antibody) indicated for treatment of patients with relapsed or refractory, low grade or follicular B-cell non-Hodgkin's lymphoma (NHL) or for patients with previously untreated follicular NHL who achieve a partial or complete response to first-line chemotherapy. "Refractory" refers to a disease that is no longer responding, or never responded, to common treatments.
Zevalin is the first radioimmunotherapy treatment to be FDA-approved as part of first-line therapy for follicular NHL. Radioimmunotherapy (RIT) is an innovative form of cancer treatment with a mechanism of action that is different from traditional chemotherapy. RIT builds on the combined effect of a targeted biologic monoclonal antibody augmented with the therapeutic effects of a beta-emitting radioisotope.
The Zevalin therapeutic regimen consists of rituximab, Indium-111 radiolabeled Zevalin (In-111) for imaging and Yttrium-90 radiolabeled Zevalin (Y-90) for therapy In-111 Zevalin for imaging allows doctors to use imaging equipment to trace the distribution of Zevalin through the body and make sure that significant amounts are not going to vital organs. The Zevalin therapeutic regimen is given on the following schedule:
- Day One
- Premedication with acetaminophen and diphenhydramine followed by administration of rituximab . Within 4 hours of rituximab infusion, treatment, In-111 Zevalin is given as an intravenous injection.
- Day Three or Four
- An imaging scan is done to confirm that the biodistribution of In-111 Zevalin in the body is acceptable and the patient can receive the therapeutic dose of Y-90 Zevalin.
- Day Seven, Eight or Nine
- Premedication with acetaminophen and diphenhydramine followed by administration of a rituximab infusion. Within 4 hours of the rituximab infusion, Y-90 Zevalin is given as an intravenous injection. Y-90 Zevalin is a monoclonal antibody combined with a radioisotope that attacks B-cells and is the therapeutic component of the Zevalin therapeutic regimen.
How It Works
Rituxan and Zevalin both target B-cells by binding to the CD20 antigen which is found on the surface of all B-cells. Zevalin is especially effective because radiation from the Y-90 isotope contained in the second Zevalin treatment, enhances the destruction of not only B-cells but of surrounding cells which may also be malignant.
It is true that, because the antibody attaches to all B-cells, that the therapy kills both healthy and unhealthy cells. Precursor cells, however, are not targeted; they remain to replenish the blood with non-cancerous B-cells.
Zevalin treatment has been shown to be extremely effective and has the added benefit of being a fast therapy that is carried out in 7-9 days. However, because it employs radioactive isotopes, Zevalin can only be administered by qualified physicians at nuclear medicine facilities.
Side Effects
The Zevalin therapeutic regimen can cause serious side effects including:
- Serious Infusion Reactions: Rituximab, alone or as part of the Zevalin therapeutic regimen, may cause serious infusion reactions. Tell your doctor or infusion nurse or get medical treatment right away if you develop fever or chills, a rash, itching, dizziness, swelling of your hands, feet or face, throat irritation or trouble breathing during or after administration of the Zevalin therapeutic regimen.
- Prolonged and severe decreases in your blood counts: Your doctor will monitor your blood counts after receiving the Zevalin therapeutic regimen. Tell your doctor if you have a fever, feel too tired to do daily activities, feel weak, develop bruises, have unusual bleeding or notice blood in your urine or stool.
- Severe skin reactions: Tell your doctor, infusion nurse or get medical treatment right away if you develop sores on your skin or in your mouth or if your skin is peeling or blistering during or after receiving the Zevalin therapeutic regimen.
Other potential serious and life-threatening side effects include:
- Extravasation: Extravasation happens when some of the drug in an IV infusion or injection, or the vein it is being injected into, leaks into the surrounding tissue. Immediately tell your doctor or infusion nurse if you have burning, pain, stinging, redness or swelling around the site in your arm where your medication is being given by vein.
- Leukemia and Myelodysplastic Syndrome: Sometimes following treatment for NHL, patients develop leukemia or myelodysplastic syndrome. This has been reported in patients that have received the Zevalin therapeutic regimen. Be sure to discuss this potential serious and life-threatening side effect with your doctor.
- Infections: The Zevalin therapeutic regimen may increase your chance of getting an infection. Be sure to tell your doctor immediately if you develop a fever, have a cough or have any flu-like symptoms.
The most common side effects of Zevalin are:
- Decreased blood counts
- Fatigue
- Stomach pain
- Nausea
- Weakness
- Diarrhea
- Cough
- Fever
- Nose and upper throat irritation
Because the Zevalin therapeutic regimen includes the use of rituximab, see prescribing information for rituximab.
Please visit www.zevalin.com for more information on the Zevalin therapeutic regimen.
Structure of ibritumomab tiuxetan (Zevalin). Image from
FDA.
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For more information on Non-Hodgkin Lymphoma and radioimmunotherapy, please see the following pages:
