Zevalin® (Ibritumomab Tiuxetan), as part of the Zevalin therapeutic regimen, is indicated for the treatment of patients with relapsed or refractory, low-grade or follicular B-cell non-Hodgkin’s lymphoma (NHL), including patients with rituximab refractory follicular NHL.
(The term refractory refers to lymphoma that does not respond to a particular therapy. The term relapsed refers to lymphoma that returns after initially responding to therapy. The terms low-grade and follicular refer to types of lymphoma cells as determined by laboratory tests.)
The Zevalin therapeutic regimen has been given accelerated approval for the treatment of relapsed or refractory, rituximab-naïve, low-grade and follicular NHL based on studies that have shown durable objective overall response rates, a surrogate endpoint for progression-free survival. Studies to determine whether the Zevalin therapeutic regimen confers an effect on progression-free survival are ongoing.
Zevalin was approved by the FDA in February of 2002. CTI completed its acquisition of Zevalin from Biogen Idec in December 2007, giving the company sole responsibility for marketing, sales, and development of the drug in the United States and returning us to a select group of biotech companies that have a commercial product.
The Zevalin therapeutic regimen uses a combination of medications or agents given in a specific order over a certain period of time. The Zevalin therapeutic regimen uses two forms of Zevalin and another agent called rituximab (brand name Rituxan®). Although the regimen involves three different agents, patients may hear doctors and healthcare professionals refer to the Zevalin therapeutic regimen as "Zevalin" for short.
The two forms of Zevalin used in the Zevalin therapeutic regimen are made by combining a monoclonal antibody with a radioisotope. Radioisotopes are atoms that give off or emit energy as radiation. When a drug is combined with a radioisotope, it is said to be radiolabeled. Zevalin can be radiolabeled with two different radioisotopes, In-111 or Y-90. Each of these radioisotopes is used for different reasons (see Frequently Asked Questions about the Zevalin Therapeutic Regimen, page 13). Each of the three agents used in the Zevalin therapeutic regimen are given through an intravenous (IV) infusion or injection. These agents are: rituximab, In-111 Zevalin (Zevalin + the radioisotope, Y-90 Zevalin (Zevalin + the radioisotope Y-90).
Each of these agents has a specific purpose and must be given in a specific order and timeframe. The entire Zevalin therapeutic regimen is given over a period of 7 to 9 days.
Zevalin is available by prescription only.
ADVERSE REACTIONS
The most common adverse reactions (40% or greater) are neutropenia, thrombocytopenia, anemia, asthenia, and gastrointestinal symptoms.
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WARNING: SERIOUS INFUSION REACTIONS, PROLONGED AND SEVERE CYTOPENIAS, and SEVERE CUTANEOUS AND MUCOCUTANEOUS REACTIONS
Serious Infusion Reactions: Deaths have occurred within 24 hours of rituximab infusion, an essential component of the Zevalin therapeutic regimen. These fatalities were associated with hypoxia, pulmonary infiltrates, acute respiratory distress syndrome, myocardial infarction, ventricular fibrillation, or cardiogenic shock. Most (80%) fatalities occurred with the first rituximab infusion [see Warnings and Precautions (5.1) and Adverse Reactions (6.1)]. Discontinue rituximab, In-111 Zevalin, and Y-90 Zevalin infusions in patients who develop severe infusion reactions. Prolonged and Severe Cytopenias: Y-90 Zevalin administration results in severe and prolonged cytopenias in most patients. Do not administer the Zevalin therapeutic regimen to patients with ≥ 25% lymphoma marrow involvement and/or impaired bone marrow reserve [see Warnings and Precautions (5.2) and Adverse Reactions (6.1)]. Severe Cutaneous and Mucocutaneous Reactions: Severe cutaneous and mucocutaneous reactions, some fatal, can occur with the Zevalin therapeutic regimen. Discontinue rituximab, In-111 Zevalin, and Y-90 Zevalin infusions in patients experiencing severe cutaneous or mucocutaneous reactions [see Warnings and Precautions (5.3) and Adverse Reactions (6.3)]. Dosing: The dose of Y-90 Zevalin should not exceed 32.0 mCi (1184 MBq). Do not administer Y-90 Zevalin to patients with altered biodistribution as determined by imaging with In-111 Zevalin [see Dosage and Administration (2.2)]. |
Resources
www.Zevalin.com
Zevalin References (118K PDF)
Please consult full prescribing information for Zevalin and rituximab, including their respective Boxed WARNINGS.
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