Alex Berenson reported in the July 14, 2007 issue of the New York Times that “market forces” are restricting the use of both Zevalin (Y90 ibitumomab tiuretan) and Bexxar (I131 tositumomab) for the treatment of non-Hodgkin’s lymphoma.[1] This same observation was made by Ken Graber in an article in the April 4, 2007 issue of the Journal of the National Cancer Institute.[2]  

Zevalin has proven to be effective for salvage or first-line treatment of low-grade lymphomas and for salvage therapy for more advanced disease. Zevalin can also be given safely with high-dose chemotherapy regimens. Bexxar also is an effective salvage treatment and can also be combined for early treatment or incorporation into transplant regimens. Wide usage of these two agents were expected following FDA approval in 2002 and 2003. 

According to the New York Times article only 1,000 doses of Zevalin and 600 doses of Bexxar were sold in 2006. This is much less than one would have expected for these two very active drugs. The main reasons cited in the article were that both Zevalin and Bexxar require referral to a radiation oncologist or a nuclear medicine specialist for dosimentry and treatment. Thus, oncologists are more likely to persist with the many other therapeutic options available including Rituxan® (rituximab). Investigators involved in using these two agents also stated that most of their referrals were for treatment of advanced disease in patients who had exhausted most other options. Expense might also be a reason for poor utilization, but costs of single agent Zevalin or Bexxar are not that much more than for a course of Rituxan. The lack of survival data was also given as a cause for low use of Zevalin and Bexxar but such data are also lacking for Fludara® (fludarabine) and Velcade® (bortezomib) and this does not affect sales. This article also pointed out that many of the patients treated with Zevalin and Bexxar were self referrals who were bypassing their primary oncologists to receive this treatment. 

The JNCI article appeared to be the main source of information for the New York Times article. In the JNCI report it was noted that due to poor sales promotion, Zevalin had been discontinued. This article points out that only a few centers have tried to use Zevalin or Bexxar. There was speculation that both agents may disappear from the market unless sales increase in the near future. 

Comments: The fact that patients have to be referred out of the oncologist's direct care is probably the main reason Zevalin and Bexxar are used so infrequently. Provision of information on Zevalin and Bexxar directly to patients with lymphoma may be the only way to increase usage.

Reference:

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