A recent news article reports on another research study singing the praises of radioimmunotherapy (RIT), as an alternative to a stem-cell transplant. In RIT, radioactive isotopes are bonded to particles of rituximab (Rituxan), which just so happens to be the drug I received in conjunction with my R-CHOP chemotherapy in 2006. The radiation, which is delivered directly to the cancer cells by the rituximab, makes RIT a one-two punch that is proving to be very effective in enhancing long-term survival.
The two leading RIT drugs are Bexxar and Zevalin.
It does require doctors to think outside the therapeutic box, because practitioners must have one foot in each of two different treatment areas - oncology and radiology - that are usually the province of different medical specialists. While RIT treatments are very expensive, typically patients need to receive just one (as compared to multiple rounds of chemotherapy or traditional targeted-beam radiation, or the vastly more expensive - and more risky - stem-cell transplantation option).
VANCOUVER, British Columbia — In patients with refractory or relapsed aggressive lymphoma, immunoradiation combined with high-dose chemotherapy is associated with better progression-free and overall survival than chemotherapy alone when used in advance of autologous stem cell transplantation.
The BEAM chemotherapy consists of BCNU, etoposide, cytarabine, and melphalan.
"We started adding immunoradiation to BEAM about 9 years ago," said Tzila Zwas, MD, professor of nuclear medicine at Tel-Aviv University in Israel. "It was the hematologists' idea, because BEAM alone extended patients' lives by a few months only. The prognosis was very grave."
When Y-90 ibritumomab tiuxetan (Zevalin) was added to high-dose chemotherapy, "it was so successful — extending lives by over 2 years — we decided to conduct a multicenter trial," she explained....
The Z-BEAM approach improved overall and progression-free survival, "which is critical in hematology," said Dr. Zwas. The researchers also found positive effects in elderly patients. "This is very good news because we are dealing mostly with elderly patients. Refractory or relapsed aggressive lymphoma is not as common in the young age group. If elderly patients can achieve quality of life with low toxicity, it's unbelievably beneficial to them," she added....
Dr. [Norman] LaFrance said he hopes to see radioimmunotherapy combined with chemotherapy in earlier stages of disease and in other indications. "It's an evolution that hasn't occurred quickly enough, but I think it will," he explained. Medical oncologists are not trained to deal with radiation therapy, and there could be issues of reimbursement. "It's complicated, it's multifactorial, but I think it's turning the corner that people think combining radioimmunotherapy with chemotherapy is the right thing to do."
- Excerpted from "Radioimmunotherapy Improves Lymphoma Survival," by Jim Kling, Medscape Medical News, Jun 14, 2013.
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