Zevalin (ibritumomab tiuxetan) is part of the Zevalin therapeutic regimen, a type radioimmunotherapy (RIT), a novel anti-cancer therapy that works much differently than traditional chemotherapy: Zevalin combines the powerful effects of radiation ("radio-") with the targeted action of a monoclonal antibody ("immuno"). It is the first radioimmunotherapy treatment to receive FDA approval as part of first-line therapy against follicular non-Hodgkin's lymphoma1.
Zevalin is administered by injection. The full treatment regimen requires up to nine days, and is divided into the following schedule1:
- Day 1
- The patient receives acetaminophen and diphenhydramine followed by an infusion of the monoclonal antibody Rituxan (rituximab). Within four hours, the patient receives In-111 Zevalin by injection.
- Day 3 or 4
- The patient undergoes an imaging study with a gamma camera.
- Day 7,8 or 9
- Provided the results of the imaging study are convincing, the patient receives acetaminophen, diphenhydramine and rituximab, and within four hours he then receives Y-90 Zevalin by IV injection.
What it's effective for and why
As we can see from the schedule, Zevalin RIT features two radioisotopes, each with different jobs2:
In-111 Zevalin, given on day 1, is a combination of two things: the monoclonal antibody ibritumomab tiuxetan (i.e. Zevalin), which seeks out the CD20 antigen found on the surface of B-cells, plus a low dose of the radioisotope Indium-111, which produces gamma emissions. These emissions are traced on day 3 or 4 by doctors using a gamma camera; doctors are looking for a certain distribution pattern of Zevalin in the body.
Y-90 Zevalin, given on day 7, 8 or 9, is a combination of the monoclonal antibody ibritumomab tiuxetan (i.e. Zevalin) combined with the radioisotope Y-90. Zevalin seeks out the CD20 antigen on B-cells and attaches itself to it, then delivers Y-90 to the cell, the beta emissions of which are strong enough to kill the cell.
Zevalin was first approved by the FDA in 2002 and is currently approved for patients with A) previously untreated follicular non-Hodgkin’s lymphoma (NHL) who achieve a partial or complete response to first-line chemotherapy, and B) relapsed or refractory low-grade or follicular B-cell non-Hodgkin's lymphoma.
Zevalin side effects: Overview
According to the manufacturer3, common side effects of the Zevalin regimen include cytopenias (a cytopenia is a deficiency in cells of the blood), fatigue, abdominal pain, nausea, nasopharyngitis (inflammation of the nasal passages or upper part of the pharynx), weakness, diarrhea, cough, and fevers. Side effects of the regimen considered to be serious include prolonged and severe cytopenias (thrombocytopenia, anemia, lymphopenia, neutropenia) and secondary malignancies (i.e. secondary cancers that develop later in life as a result of anti-cancer treatment).
Click HERE to view ongoing clinical trials of Zevalin through the National Cancer Institute's PDQ Cancer Clinical Trials Registry.
References
- Lymphoma Information Network (LIN): Zevalin
- LIN: A Closer Look at the Zevalin Therapeutic Regimen
- Spectrum Pharmaceuticals: Adverse reactions of Zevalin
