Evidence Mounts for the Efficacy of Radioimmunotherapy for B-Cell Lymphomas

Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA.
Journal of Clinical Oncology (Impact Factor: 18.43). 11/2008; 26(32):5147-50. DOI: 10.1200/JCO.2008.18.5447
Source: PubMed

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    • "Such data suggest that it may be preferable to move up 90Y-IT treatment in the sequence of therapy for lymphoma, in order to take advantage of the high likelihood of achieving a CR, which confers a longer TTP. In fact, a response rate of 100% has been reported after first-line use of RIT in patients with follicular lymphoma.18 Late toxicity and particularly myelodysplasia seems not to be an issue, so that subsequent treatments upon relapse are possible.19,20 "
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    ABSTRACT: Several studies have indicated that radioimmunotherapy is an effective and clinically relevant complementary therapeutic approach for patients with B-cell non-Hodgkin's lymphoma (NHL) and may convert partial to complete response when given as consolidation after induction chemotherapy. Yttrium-90((90)Y)-ibritumomab tiuxetan ((90)Y-IT, Zevalin(®), Y2B8) has documented efficacy for both indolent and aggressive NHL. Patients considered eligible for (90)Y-IT treatment should satisfy several screening criteria. A recently completed randomized study for patients with follicular lymphoma has demonstrated that (90)Y-ibritumomab consolidation also produced a marked prolongation of the median time to progression from 13.5 to 37 months, while partial responders seem to derive relatively more benefit. Other published and ongoing studies explore a similar use for patients with aggressive lymphoma. Studies are comparing the use of (90)Y-IT consolidation with the anti-CD20 antibody rituximab maintenance, which is also gaining acceptance. In conclusion, the documented benefit of radioimmunotherapy should be viewed in the context of the goals of treatment and the changing standards of care for lymphoma.
    Preview · Article · Oct 2009 · Cancer Management and Research
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    ABSTRACT: Antibody-based therapies, both unconjugated antibodies and radioimmunotherapy, have had a significant impact on the treatment of non-Hodgkin lymphoma. Single-agent rituximab is an effective therapy, but it is being increasingly used with combination chemotherapy to improve the objective response and its duration. The approved anti-CD20 radioimmunoconjugates ((90)Y-ibritumomab tiuxetan or (131)I-tositumomab) have had encouraging results, with trials now seeking to incorporate a radioimmunoconjugate in various settings. However, new preclinical data raise important questions concerning current radioimmunoconjugate treatment regimens and ways to improve them. In radioconjugate therapy, nearly 900 mg of the unlabeled anti-CD20 IgG antibody is predosed to the patient before the anti-CD20 antibody conjugated to either (90)Y or (131)I is given. Combining an unconjugated anti-CD20 antibody therapy with a radioimmunoconjugate binding to a noncompeting antigen might improve responses by allowing optimal uptake of each agent. Preclinical models have indicated that careful consideration should be given to predosing when using competing antibodies, but that consolidation anti-CD20 therapy enhances the efficacy of radioimmunoconjugate therapy. New technologies, such as pretargeted radioimmunotherapy, also hold promise by reducing toxicity without sacrificing efficacy, and consideration should be given to fractionating or giving multiple radioimmunoconjugate treatments. This perspective discusses how these issues could affect current and future clinical trials.
    No preview · Article · Feb 2009 · Blood
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    Full-text · Article · Feb 2009 · Journal of Clinical Oncology
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