RIT Approved Uses and When It Is Best Used
To clear up any confusion, RIT is approved for the following uses:
Both Zevalin and Bexxar are approved for patients with follicular lymphoma as a second line treatment. In other words, patients must have taken either chemo, Rituxan or a combination of the two before RIT can be used.
Interestingly, CVP is the only chemotherapy which has been approved to be used in combination with Rituxan for follicular lymphoma. CHOP is the only chemotherapy approved to be used in combination with Rituxan for diffuse large B-cell lymphoma. Almost everyone knows that CHOP plus Rituxan is commonly used in patients who have follicular lymphoma. The point is that Rituxan is commonly used "off label," that is, in ways that it has not been approved by the FDA. This is not uncommon in the practice of medicine, but the question must be asked why RIT is so rarely prescribed even for the use for which it was approved, especially when there is an impressive amount of data which substantiates the benefits.
There are 3 studies in particular which I cite:
1. From Christos Emmanoulides, et al, published in June 2005. The authors studied 4 clinical trials conducted at 30 centers. The patients had follicular lymphoma or transformed B-cell NHL. 30% of the patients were given Zevalin as their second treatment. The remaining 70% of the patients had previously had two or more treatments. The complete response was higher when Zevalin was used after the first relapse (49% versus 28% of the total population and 51% versus 28% for the follicular population). The authors concluded that Zevalin produced a consistently higher overall response rate and longer durable remission when used as the second treatment, rather than after two or more prior therapies. They also noted that "there were long-term durable remissions in 37% of the patients, some of them longer than 75 months." This study also noted that future treatments were possible if necessary.
2. From the ASCO 2006 Conference, DeMonaco, et al, reported use of R-CHOP followed by Zevalin in follicular lymphoma patients. The authors observed that the complete response rate jumped from 36% with R-CHOP alone to 89% when Zevalin followed R-CHOP.
3. From ASCO, 2005 Conference, Stephanie Gregory (Rush University) et al. The authors reviewed treatment responses in 1,177 patients in 10 clinical trials in which Bexxar was used as first, second, third, fourth or more treament. They found that "response rates, complete response rates, and associated durations of response to Bexxar all increased significantly as the number of prior therapies decreased." The results showed the following complete responses: 78% when used as first treatment; 46% when used as second treatment; 32% when used as third treatment; and 23% when used as the fourth or later treatment. The progression free survival also improved dramatically when Bexxar was used earlier in treatment rather than later.
These studies provide solid evidence that RIT has a better chance of working when it is used earlier. If anyone wants the links to these studies to show their own oncologists, please let me know. I will gladly provide them to you.
Betsy
Comments
Hi, my name is Alex. In August of 2006, I was diagnosed with what was initially transformed follicular NHL. I had 6 rounds of R-CHOP. Then I was refered to University of Penn where they were convinced that my diagnosis was DLBCL. I had my bone marrow harvested and have recently completed 22 rounds of external beam radiation. I am scheduled for a CT scann in the middle of March to see how much is left of the tumor. Does anyone have any information about RIT vs stem cell transplant if relapse occurs.
Thank you.
Posted by: Alex Negron | February 22, 2007 3:48 PM
I am Canadian and have never heard of RIT. My Father who has follicullar Lymphoma has been treated once with R-CHOP and was in remission for a little over a year. In the last month we see signs of it's return; swollen nodes, coughing, night sweats, weight loss, decreased apetite. Can we in Canada ask for RIT following the required coarses of R-CHOP? Time is of the essence so please answer swiftly! Thanks so much for your willingness to help us.
Carole
Posted by: Carole Dagenais | February 26, 2007 8:05 PM