Care During Chemotherapy and Beyond
Trade name: ZevalinTM
Other name: Ibritumomab Tiuxetan
Drug type: Ibritumomab is a monoclonal antibody that is linked
with a radioactive substance Yttrium-90. (For more detail, see "How this drug works"
What This Drug Is Used For:
- Treatment of certain types of non-Hodgkin's lymphoma that have recurred after, or
not responded to prior treatment.
Note: If a drug has been approved for one use, physicians
may elect to use this same drug for other problems if they believe it may be helpful.
How This Drug Is Given:
- Infusion into a vein (intravenous, IV).
- Given only as part of a protocol in combination with the drug rituximab (see rituximab).
Two step protocol:
- Step 1 - Rituximab infusion starting at a slow rate. The
rate is increased if no allergic or infusion related events occur (usual infusion
time about 4-6 hours). Within 4 hours of the completion of this infusion,
a radiolabeled tracer is injected over 10 minutes into the vein. Body scans
are done 2-24 hours, 48-72 hours, and sometimes 96-120 hours later to check the
distribution of the drug throughout the body. If the readings are acceptable
the patient will proceed to Step 2.
- Step 2 - 7-9 days following Step 1, rituximab infusion is again
given as above. Within 4 hours of the completion of the rituximab infusion
the treatment dose of ibritumomab (ibritumomab linked with yttrium-90) is infused
over 10 minutes.
- The amount of ibritumomab that you will receive depends on many factors, including
your height and weight, your general health or other health problems, and the type
of cancer or condition being treated. Your doctor will determine your dose
Important things to remember about the side effects of ibritumomab:
- Most people do not experience all of the side effects listed.
- Side effects are often predictable in terms of their onset and duration.
- Side effects are almost always reversible and will go away after treatment is complete.
- There are many options to help minimize or prevent side effects.
- There is no relationship between the presence or severity of side effects and the
effectiveness of the medication
The following side effects are common (occurring in more than 30%) for patients
- Low blood counts. Your white and red blood cells and platelets may temporarily
decrease. This can put you at increased risk for infection, anemia and/or
bleeding. (This effect may be delayed or prolonged for several weeks after
treatment is given).
Nadir: Meaning low point, nadir is the point in time between chemotherapy
cycles in which you experience low blood counts.
Onset: none noted
Nadir: 7-9 weeks
These are less common side effects (occurring in 10-29%) for patients receiving
- Fever, chills (see flu-like symptoms)
- Abdominal pain
- Shortness of breath
- Cough, throat irritation
A serious but rare side effect of ibritumomab regimen (in combination with
rituximab) is potential for a severe infusion reaction, typically during first rituximab
infusion (during infusion or within 30-120 minutes of infusion).
Not all side effects are listed above. Some that are rare (occurring in less than
10% of patients) are not listed here. However, you should always inform your
health care provider if you experience any unusual symptoms.
When to contact your doctor or health care provider:
Contact your health care provider immediately, day or night, if you
should experience any of the following symptoms:
- Fever of 100.4° F (38° C) or higher, chills (possible signs of infection)
- Shortness of breath, chest pain or discomfort; swelling of your lips or throat
The following symptoms require medical attention, but are not an emergency.
Contact your health care provider within 24 hours of noticing any of the
- Nausea (interferes with ability to eat and unrelieved with prescribed medication)
- Vomiting (vomiting more than 4-5 times in a 24 hour period)
- Diarrhea (4-6 episodes in a 24-hour period)
- Unusual bleeding or bruising
- Black or tarry stools, or blood in your stools or urine
- Extreme fatigue (unable to carry on self-care activities)
Always inform your health care provider if you experience any unusual symptoms.
- Before starting ibritumomab treatment, make sure you tell your doctor about any
other medications you are taking (including prescription, over-the-counter, vitamins,
herbal remedies, etc.). Do not take aspirin, products containing aspirin unless
your doctor specifically permits this.
- Because of the high incidence of low platelet counts associated with ibritumomab,
avoid such herbs such as; cat's claw, dong quqi, evening primrose, feverfew, garlic,
ginger, ginkgo, red clover, horse chestnut, green tea, ginseng (all have antiplatelet
activity). Discuss with your doctor when it might be safe to resume.
- Do not receive any kind of immunization or vaccination without your doctor's approval
while taking ibritumomab.
- Inform your health care professional if you are pregnant or may be pregnant prior
to starting this treatment. Pregnancy category D (ibritumomab may be hazardous to
the fetus). Women who are pregnant or become pregnant must be advised of the
potential hazard to the fetus.
- For both men and women: Do not conceive a child (get pregnant) while taking ibritumomab.
Barrier methods of contraception, such as condoms, are recommended. Discuss with
your doctor when you may safely become pregnant or conceive a child after therapy.
- Do not breast feed while taking this medication.
- Once the radio-labled product (ibritumomab, yttrium 90) is infused, the body is
a shield to the low dose of radiation that is emitted. No special radiation
safety precautions are necessary.
- Drink at least two to three quarts of fluid for the first 48 hours after each infusion,
unless you are instructed otherwise.
- You may be at risk of infection so try to avoid crowds or people with colds or not
feeling well, and report fever or any other signs of infection immediately to your
health care provider.
- Wash your hands often.
- Use a soft toothbrush to minimize bleeding.
- Avoid contact sports or activities that could cause injury.
- To reduce nausea, take anti-nausea medications as prescribed by your doctor, and
eat small, frequent meals.
- In general, drinking alcoholic beverages should be kept to a minimum or avoided
completely. You should discuss this with your doctor.
- Get plenty of rest.
- Maintain good nutrition.
- If you experience symptoms or side effects, be sure to discuss them with your health
care team. They can prescribe medications and/or offer other suggestions that
are effective in managing such problems.
Monitoring and Testing:
You will be checked regularly by your healthcare professional after taking ibritumomab,
to monitor side effects and check your response to therapy. Periodic blood
work to monitor your complete blood count (CBC) as well as the function of other
organs (such as your kidneys and liver) will also be ordered by your doctor.
How This Drug Works:
Ibritumomab is classified as a monoclonal antibody. Monoclonal antibodies
are a relatively new type of "targeted" cancer therapy.
Antibodies are an integral part of the body's immune system. Normally, the
body creates antibodies in response to an antigen (such as a protein in a germ)
that has entered the body. The antibodies attach to the antigen in order to
mark it for destruction by the immune system.
To make anti-cancer monoclonal antibodies in the laboratory, scientists analyze
specific antigens on the surface of cancer cells (the targets). Then, using
animal and human proteins, they create a specific antibody that will attach to the
target antigen on the cancer cells. When given to the patient, these monoclonal
antibodies will attach to matching antigens like a key fits a lock.
Since monoclonal antibodies target only specific cells, they may cause less toxicity
to healthy cells. Monoclonal antibody therapy is usually given only
for cancers in which antigens (and the respective antibodies) have been identified
Ibritumomab works by targeting the CD20 antigen on normal and malignant B-cells.
However, it is more than a monoclonal antibody alone. In the laboratory, a
radioactive substance (yttrium-90) is linked to the antibody. When the antibody
attaches to the CD20 antigens, radiation is delivered directly to the targeted cells,
killing the targeted cells as well as cancer cells in the immediate area.
Stem cells (young cells in the bone marrow that will develop into the various types
of cells) do not have the CD20 antigen. This allows healthy B-cells to regenerate
after treatment. This is also known as radioimmunotherapy.
Note: We strongly encourage you to talk with your health
care professional about your specific medical condition and treatments. The information
contained in this website is meant to be helpful and educational, but is not a substitute
for medical advice.
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