Radioimmunotherapy in Non-Hodgkin Lymphoma: Opinions of U.S. Medical Oncologists and Hematologists

Radioimmunotherapy of relapsed indolent non-Hodgkin lymphoma with 131I-rituximab in routine clinical practice: 10-year single-institution experience of 142 consecutive patients

“…20 In Western Australia, 131 I-rituximab has been approved for administration to patients in an ambulatory setting, just as 131 I-tositumomab may be given to outpatients in the United States, which avoids the expense and radiation isolation exigencies of inpatient treatment. 14 An ongoing study at Fremantle Hospital using 131 I-rituximab RIT as first-line treatment for advanced indolent lymphoma in 50 patients showed interim ORR of 98% and CR of 78%, 9 which is comparable with the encouraging results of first-line RIT with 131 I tositumomab in advanced follicular lymphoma. 8 Despite the overwhelming body of evidence that has accumulated regarding the benefits of RIT in respect of disease response and quality of life, RIT remains underused in the United States and other countries.…”

“…Concern has been expressed that RIT may not be available in the future due to poor sales and a lack of promotion by pharmaceutical companies, 11 which compounds logistic and regulatory constraints, leading to restricted use in the United States and other countries. [11][12][13][14] In Australia, although 90 Y-ibritumomab tiuxetan (Zevalin) has been approved by the Therapeutic Goods Administration, it is not funded by the Pharmaceutical Benefits Scheme and it is seldom used. However, the rapid, convenient, semiautomated routine preparation of 131 I-rituximab in a university hospital nuclear medicine department makes cost-effective RIT readily available to patients in Australia as an outpatient treatment.…”

“…13,14 131 I-rituximab has been used in relapsed and refractory NHL in small studies in Germany 16 and South Korea 17 in small numbers of heavily pretreated patients with a variety of NHL types, reporting ORRs of 30%-50%, which approached that of 131 I-tositumomab (47%-68%) in similar patients. 27 Five years after we commenced RIT of NHL with 131 I-rituximab, Bienert et al 16 described their experience in Germany with 131 I-rituximab in 9 heavily pretreated patients with B-cell lymphoma.…”

Proceedings of the Second NCI–SNMMI Workshop on Targeted Radionuclide Therapy

“…This may be due, at least in part, to concerns about cost, radiation effects, and a perceived lack of data from large randomized trials comparing radioimmunotherapy with nonradioactive lymphoma therapy. There is also concern about a potential negative financial effect from patient referral to a nuclear medicine physician or a radiation oncologist (10).…”

Advances in the treatment of hematologic malignancies using immunoconjugates

“…Logistical issues involving the transfer of care from the treating oncologist/hematologist to the nuclear medicine physician, economic concerns about insufficient reimbursement and expense, and an exaggerated emphasis on delayed effects such as marrow damage and secondary malignancies have contributed to the limited use of RIT. 71 Importantly, the inability to administer RIT locally at community practice sites with the resultant need for referral to distant centers has been a major economic disincentive. Although the development of strategies to further improve RIT efficacy and extend its use to other hematologic malignancies is continuing, reducing the logistic hurdles to RIT administration will be essential for more widespread adoption of the next generation of RICs.…”