Article

Efficacy and Safety of Tositumomab and Iodine-131 Tositumomab (Bexxar) in B-Cell Lymphoma, Progressive after Rituximab

Stanford University, Stanford, CA 94305-5821, USA.
Journal of Clinical Oncology (Impact Factor: 18.43). 03/2005; 23(4):712-9. DOI: 10.1200/JCO.2005.07.040
Source: PubMed

ABSTRACT To determine overall response (OR) and complete response (CR) rates, response duration, progression-free (PFS) and overall survival and safety with the tositumomab and iodine-131 tositumomab ((131)I tositumomab) therapeutic regimen in patients with indolent, follicular large-cell, or transformed B-cell lymphoma, progressive after rituximab.
From July 1998 to November 1999, 40 patients (24 rituximab nonresponders: 11 with response < 6 months, and five with response > or = 6 months) received a therapeutic dose (0.65 to 0.75 Gy per platelet count) of (131)I tositumomab based on total-body dosimetry in this prospective phase II study. The median number of prior treatments was four; 59% of patients were chemotherapy-resistant.
Confirmed OR (65%) and CR (38%) rates were not significantly associated with prior rituximab response. With a median follow-up of 3.3 years, the median PFS was 10.4 months, 24.5 months for responders, and not reached for CR patients. Among follicular grade 1 or 2 patients with tumors < or = 7 cm (n = 21), the OR and CR rates were 86% and 57%. Estimated 3-year PFS in this subgroup was 48%, compared with 11% for all others (P = .002). Transient grade 3 to 4 marrow toxicity was seen in 50% of patients. Two patients, one of whom received two subsequent chemotherapy regimens, developed secondary myelodysplasia.
(131)I tositumomab is effective in CD20-positive lymphoma progressive after rituximab, with a 65% OR rate and median PFS of 24.5 months for responders. Patients with follicular grade 1 or 2 histology and tumors < or = 7 cm achieved very high OR and CR rates, with 48% PFS at 3 years.

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    • "To our knowledge, safety data from registration trials of B have not been pooled in a separate publication and can only be extrapolated from the official product insert [40]. A number of adverse reaction to the infusion were reported, including fever, chills, sweating, hypotension, nausea, bronchospasm [17] [18] [19] [20] [21]. All these events were transient and manageable. "
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    • "Two antibodies, 90 Y-ibritumomab tiuxetan (Zevalin) and 131 I-tositumomab (Bexxar) are already FDA approved for the treatment of relapsed/refractory indolent B-NHL and 90 Y-ibritumomab tiuxetan has been approved for consolidation of FL. Their efficacy has been well documented in multiple clinical trials (Witzig et al, 2002; Horning et al, 2005; Kaminski et al, 2005; Morschhauser et al, 2007). Radioimmunotherapy continues to be investigated regarding its role in up-front therapeutic regimens with or without rituximab, as consolidation/maintenance therapy following treatment for FL and as an element in conditioning regimens for SCT. "
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