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Harnessing the Energy: Development of Radioimmunotherapy for Patients with Non-Hodgkin's Lymphoma

^aRush University Medical Center, Chicago, Illinois, USA; ^bUniversitätsmedizin Göttingen, Göttingen, Germany; ^cHôpital Saint-Louis, Paris, France; ^dNational Cancer Center Hospital, Tokyo, Japan; ^eKlinikum der Universität München, Munich, Germany

Key Words. Radioimmunotherapy • Lymphoma • Non-Hodgkin's lymphoma • Yttrium-90-ibritumomab tiuxetan • Patient selection • Iodine-131-tositumomab

Correspondence: Stephanie A. Gregory, M.D., Section of Hematology, Rush University Medical Center/Rush University, 1725 West Harrison Street, Suite 834, Chicago, Illinois 60612, USA. Telephone: 312-942-5982; Fax: 312-563-4101; e-mail: stephanie_gregory{at}rush.edu

Received March 27, 2009; accepted for publication July 6, 2009.

Disclosures: Stephanie A. Gregory: Honoraria: GlaxoSmithKline, Genentech; Karin Hohloch: None; Christian Gisselbrecht: Research funding/contracted research: Bayer Schering Pharma; Kensei Tobinai: None; Martin Dreyling: Honoraria: Roche, Bayer, Schering; Research funding/contracted research: Roche, Bayer, Schering.

This article discusses ⁹⁰Y-ibritumomab tiuxetan (Bayer Schering Pharma AG, Spectrum Pharmaceuticals, Inc.), a radioimmunotherapeutic agent, to minimize the systemic effects of radiation, as therapy in NHL patients with relapsed low-grade NHL and for consolidation therapy after frontline chemotherapy.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the independent peer reviewers.

Radioimmunotherapy (RIT) combines the use of targeted monoclonal antibodies with radionuclides for the treatment of non-Hodgkin's lymphoma (NHL), taking advantage of its inherent radiosensitivity. A number of trials have shown significantly higher response rates and longer progression-free survival times in patients treated with the CD20-targeted radioimmunoconjugate yttrium-90-ibritumomab tiuxetan compared with the standard of care. Furthermore, these benefits have also been shown in heavily pretreated patients who relapsed or were resistant to rituximab. Currently, a number of different treatment regimens and strategies are available for the treatment of NHL patients. Therefore, in an attempt to minimize toxicity, maximize efficacy, and improve survival, it is crucial to appropriately select patients who are good candidates for individual treatment approaches. A strategy for patient selection has been developed, including the use of existing patient assessment tools, such as the Follicular Lymphoma International Prognostic Index, to determine the optimal regimen for patients with follicular lymphoma according to their disease characteristics and physical condition. Patients who are fit make ideal candidates for potentially curative regimens, which include induction chemotherapy with or without immunotherapy followed by RIT consolidation and, potentially, maintenance therapy. Patients who are considered "compromised" would also benefit from induction treatment and RIT consolidation, with a view to reducing the lymphoma burden and decreasing the risk for disease progression. "Frail" patients would be better suited to supportive therapy to control symptoms. This paper explores factors that should be considered when assessing whether a patient is a good candidate for treatment with RIT, and aids physicians in the selection of the most appropriate therapy for each patient group.

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