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March 13, 2008 NEW YORK (Reuters Health) - In patients with advanced follicular non-Hodgkin's lymphoma who have not received previous treatment, radioimmunotherapy with Y-90-ibritumomab tiuxetan (Zevalin) improves the response to initial chemotherapy, according to results of a phase II trial in Italy. "This study has established the feasibility, tolerability, and efficacy of sequential treatment with six cycles of fludarabine and mitoxantrone chemotherapy followed by Y-90-ibritumomab tiuxetan as a front-line treatment for untreated patients with follicular NHL," the investigators report in The Lancet Oncology published online on March 12th. Y-90-ibritumomab tiuxetan is a monoclonal antibody to the B-cell CD20 antigen, "one of the most active agents in the treatment of lymphoma," Dr. Pier Luigi Zinzani at the University of Bologna and his associates explain. "When applying these radiolabeled immunotherapies in clinical practice, the main challenge is in identifying the most effective integration of these agents into the treatment approach." Included were 61 patients with stage III or IV untreated indolent follicular NHL that expressed the CD20 antigen. The overall response rate after chemotherapy was 98%: 43 had a complete response, 17 had a partial response, and 1 had progressive disease. Six to 10 weeks after completing chemotherapy, all of the patients who had a complete response, and 14 patients who had a partial response with bone marrow infiltration of less than 25%, underwent immunotherapy with two infusions of rituximab 1 week apart, followed by Y-90-ibritumomab tiuxetan (maximum total dose of 1184 MBq). All but two patients had a complete response after Y-90-ibritumomab tiuxetan treatment. Furthermore, 14 of 18 patients tested achieved molecular complete remission, defined as the absence of BCL-IgH rearrangement in bone marrow and peripheral blood. "With a median follow-up of 30 months," Dr. Zinzani's team reports, "3-year progression-free survival was estimated to be 76% and 3-year overall survival 100%." Copyright 2008 Reuters. Click for Restrictions.
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