3. APPLICATION
Used alone or in combination with iodine I 131
Used to treat CD20-positive, relapsed or refractory non-Hodgkin's lymphoma
Not used for initial treatment of patients with CD20-positive NHL
Used only as a single course of treatment
5. MECHANISM OF ACTION
Binds to the CD20 (human B-lymphocyte restricted differentiation antigen) antigen
This antigen is found on >90% of B-cell NHL
Bexxar acts through:
Addition of ionizing radiation
Induction of apoptosis
Complement dependent cytotoxicity
Antibody-dependent cellular toxicity
6. DOSE
Given as IV solution
Dose for non-Hodgkin's lymphoma is tositumomab 450mg IV infusion over 60 minutes
Follow by I-131 tositumomab dose (calculated to deliver 75cGy total body irradiation for
patients with normal platelet count) for 7 to 14 days
For those with decreased platelet count therapeutic dose adjusted to 65cGy total body
irradiation
8. CLEARANCE
Average clearance of the drug 68.2 mg/hr
Patients with high tumor burden, splenomegaly, or bone marrow involvement have faster
clearance and shorter terminal half-life
The medial total body effective half-life is 67 hours
Elimination of Iodine – 131 occurs by decay and is excreted in urine
After five days whole body clearance is 67% with 98% of clearance accounted for in urine
10. Storage requirements
Store at 36F to 46F (2o
C – 8o
C) and protect from strong
light
Thaw directly prior to administration and Do not shake
When diluted tositumomab stable for 24 hours
refrigerated and 8 hours at room temperature
Thawed I131 tositumomab stable for up to 8 hours at
room temperature
11. Dose preparation and disposal
Must be prepared directly before administration
Unused portion and infusion set components must be
discarded according to laws regarding radioactive and
biohazardous waste
12. MONITORING
Monitor for infusion reactions
decreased rate by 50% for mild – moderate reactions
Interrupt infusion for serious reactions and resume at 50% of original if reaction resolves
Monitor for grade 3 or 4 cytopenias up to 3 months after treatment (primarily thrombocytopenia
and neutropenia
Life-long monitoring for hypothyroidism
13. PREGNANCY AND
BREASTFEEDING
Pregnancy
High risk to fetus in all trimesters
Males and females should used contraception to prevent
pregnancy during and for 12 months after stopping drug
Breastfeeding:
Harmful to infant
14. PRECAUTIONS
Serious allergic reactions (i.e. anaphylaxis – rash, itching,
fever, chills, light-headedness or dizziness, nausea, trouble
breathing or swelling of hands, face, mouth or throat)
Causes susceptibility to infection (because of temporary
decreased number of WBCs)
Bleeding (due to decreased number of platelets)
May increase chance of certain cancer types or thyroid
problems