Researchers from Italy have reported that six cycles of Fludara® (fludarabine) and Novantrone® (mitoxantrone) followed by Zevalin® (yttrium-90 ibritumomab tiuxetan) resulted in complete remission (CR) in 55 of 57 patients with newly diagnosed follicular lymphoma. The details of this Phase II study appeared in an early online publication in Lancet Oncology on March 13, 2008.¹

Zevalin is a murine IgG1 kappa monoclonal antibody conjugated to tiuxetan (MXDTPA) that chelates yttrium or indium and is directed against the CD 20 molecules of B lymphocytes. Rituxan® (rituximab), 250 mg/m2, is usually given seven days and one day before Zevalin. Zevalin can be administered with or without stem cell support depending of the dose used. The rationale for using a targeted radio-labeled isotope is to decrease toxicity by the delivery of more specific radiotherapy. Zevalin is one of the most active treatments available for treatment of patients with non-Hodgkin’s lymphoma (NHL), but the need for nuclear medicine monitoring has led to less than predicted use in the general oncology community. A previous randomized trial reported that Zevalin consolidation prolongs progression-free survival (PFS) and improved the CR rate in patients with advanced follicular lymphoma who achieved a partial response (PR) CR to first-line chemotherapy.

The current multicenter trial enrolled 61 patients with previously untreated follicular lymphoma. The overall response rate to six cycles of Fludara and Novantrone was 98%, with 43 patients achieving a CR.  Fifty-seven patients received Zevalin. Twelve of 14 patients with a PR achieved a CR after Zevalin. Thus 55 of 57 patients ultimately achieved a CR. The three-year progression-free survival was 75%, and the overall survival was 100%.

Comments: These data confirm the effectiveness of Fludara and Novantrone induction and Zevalin consolidation in patients with follicular lymphoma.

Related News:

Zevalin® Consolidation Prolongs Progression-Free Survival in Patients with Advanced Follicular Non-Hodgkin’s Lymphoma (NHL) (01/29/2008)

Zevalin® Effective When Used as First-Line Consolidation in Advanced Mantle Cell Lymphoma (06/19/2006)

Effectiveness of Zevalin™ (90Yttrium-2b8 ibritumomab tiuxetan) for Treatment of Patients with Follicular Lymphoma Who Have Failed Rituxan® Confirmed (8/26/2002)

Reference:

¹ Zinzani L, Tani M, Putsoni A, et al. Fludarabine and mitoxantrone followed by yttrium 90 ibritumomab in previously untreated patients with follicular non-Hodgkin lymphoma trial: a phase II non-randomised trial (FLUMIZ). Lancet Oncology [early online publication]. March 13, 2008.