Can radioimmunotherapy help make chemotherapy more effective for patients with follicular lymphoma?

This study examined if Y-90 (Zevalin) improved the effectiveness of chemotherapy for follicular lymphoma.  The authors found that Y-90 improved the effectiveness of chemotherapy and was generally safe.

Follicular lymphoma (FL) is a type of non-Hodgkin lymphoma.  It is usually treated with chemotherapy.  BR (bendamustine, rituximab) chemotherapy has been shown to be safer and just as effective as R-CHOP. However, further treatment called consolidation therapy may help further improve patient outcomes.

Radioimmunotherapy is one type of consolidation therapy. This type of treatment combines immunotherapy and radiotherapy. It uses monoclonal antibodies that release radiation directly on the tumor. This leads to cancer cell death. Whether Y-90 after BR chemotherapy is safe and more effective than BR alone for patients with FL is unclear.

This study had 39 patients with previously untreated FL. Patients first received 4 cycles of BR chemotherapy. Then, patients received Y-90 6 to 12 weeks later. CT scanning was done at 12 weeks, 6 months, and then annually. Patients were followed-up for an average of 45 to 52 months.

After BR chemotherapy, 56% of patients completely responded to treatment (no signs of cancer). 41% of patients had a partial response (tumor shrinkage). After Y-90 treatment, the number of patients who completely responded to treatment increased to 88.6%.  Furthermore, 81% of patients with a partial response after BR chemotherapy had no signs of cancer after Y-90 treatment.

Overall, 96% of all patients were still alive 52 months later. 71% of patients did not have tumor growth or spread 45 months later.

BR chemotherapy was well-tolerated. 3 patients developed seriously low white blood cell levels. During radioimmunotherapy, 76% of patients had seriously low white blood cell levels. Low platelet levels (blood clotting cells; 74%) and low red blood cell levels (6%) were also reported.

This study concluded that Y-90 treatment increased the effectiveness of subsequent BR chemotherapy, and was well-tolerated by patients with FL. 

This study had a small number of patients and a short follow-up period (45 months).  The study excluded patients who did not respond to BR chemotherapy and did not include a comparison treatment.  Also, this study was co-funded by the manufacturers of the drugs, Teva and Spectrum Pharmaceuticals.

Talk to your physician about the potential benefits of radioimmunotherapy.