Sequential R-CHOP followed by Zevalin® (ibritumomab tiuxetan) produces encouraging outcomes in high-risk elderly patients with diffuse large B-cell lymphoma, according to the results of a study presented at the 52nd annual meeting of the American Society of Hematology (ASH) in Orlando, Florida.
Non-Hodgkin’s lymphoma (NHL) refers to a group of cancers that originate in different cells of the immune system. Diffuse large B-cell NHL is a common type of NHL that affects immune cells called B-cells; it is considered an aggressive type of NHL.
Standard treatment for DLBCL typically includes R-CHOP, which refers to treatment with the monoclonal antibody Rituxan® (rituxamab) plus cyclophosphamide/Adriamycin/vincristine/prednisone (CHOP). Although this regimen has led to improved outcomes, there is a group of poor-risk patients who need an alternative treatment strategy.
Zevalin is a type of radioimmunotherapy treatment (RIT) that combines the monoclonal antibody Rituxan with Zevalin, which is comprised of an anti-CD20 monoclonal antibody and Yttrium-90, a radioisotope that delivers the radiation. When injected into the body, Zevalin attaches to a protein (CD20) found only on the surface of B-lymphcytes, such as cancerous B-cells found in many forms of non-Hodgkin’s lymphoma. The radioactivity that is spontaneously emitted targets the B-cell and destroys it. This approach protects healthy tissue.
Zevalin has been shown to be a highly effective treatment-and has the added benefit of being administered over a single short period of time. Zevalin is administered on an outpatient basis and the total duration of therapy is less than 10 days. Zevalin offers active patients the opportunity to spend less time undergoing treatment than more conventional chemotherapy.
Researchers conducted a study of 63 evaluable patients with DLBCL and a median age of 75. All patients were untreated and were ineligible for stem cell transplantation. Patients received six cycles of R-CHOP and then those with responding or stable disease received Zevalin 6-9 weeks later.
Following R-CHOP treatment, 50 patients were eligible for Zevalin and 44 were ultimately treated. Zevalin was generally well tolerated and 86 percent of patients experienced a complete response (CR) or unconfirmed complete response (CRu), while 2 percent experienced a partial response. Response improvement (from PR to CR or CRu to CR) occurred in 16 percent of patients. At 42 months, the overall survival for Zevalin treated patients was 83.5 percent and the progression-free survival was 74.5 percent.
The researchers concluded that sequential R-CHOP plus Zevalin is well tolerated and is associated with encouraging outcomes in high-risk elderly patients with DLBCL.
Hamlin PA, Rodriguez MA, Noy A, et al. Final results of a phase II study of sequential R-CHOP and Yttrium-90 Ibritumomab Tiuxetan (RIT) for elderly high risk patients with untreated diffuse large B-cell lymphoma (DLBCL). Blood. 2010; 116(21): Abstract 1793.
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