Bexxar
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Bexxar is a monoclonal antibody used to treat relapsed or refractory CD20-positive non-Hodgkin's lymphoma. It binds to the CD20 antigen on B-cells and works through radiation induction, apoptosis, complement dependent cytotoxicity, and antibody-dependent cellular toxicity. Bexxar is given as a 450mg IV infusion followed by a calculated dose of radioactive iodine 7 to 14 days later to deliver radiation to lymphoma cells. Common side effects include cytopenias, infusion reactions, and long-term risk of hypothyroidism.
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The document discusses thrombocytopenia (low platelet count) and the use of eltrombopag to treat chronic immune thrombocytopenia. Eltrombopag is an oral thrombopoietin receptor agonist that stimulates platelet production. A 6-month study of 135 patients treated with eltrombopag found that 79% responded well with platelet counts between 50,000-400,000, with few serious bleeding events or thromboembolic risks compared to placebo. Transient increases in liver enzymes were reported in some patients treated with eltrombopag. The conclusions are that eltrombopag seems beneficial for patients who do not respond to other treatments for chronic immune thrombocytopenia, but further studies
Bexxar
Bexxar is a monoclonal antibody used to treat relapsed or refractory CD20-positive non-Hodgkin's lymphoma. It binds to the CD20 antigen on B-cells and works through radiation, apoptosis induction, complement dependent cytotoxicity, and antibody-dependent cellular toxicity. Bexxar is given as a 450mg IV infusion followed by a calculated dose of I-131 tositumomab 7 to 14 days later. Common side effects include cytopenias, infusion reactions, and hypothyroidism. Precautions must be taken due to the radioactive iodine component.
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Bexxar
- 2. GENERAL INFORMATION Therapeutic class: Antineoplastic agent Pharmacologic class: Monoclonal antibody
- 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 AND CLEARANCE 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 Clearance of the drug is 68.2 mg/hr.
- 7. Storage requirements Store at 36F to 46F (2oC – 8oC) 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
- 8. 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
- 9. 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
- 10. 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
- 11. 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
- 13. SIDE EFFECTS (require immediate medical attention) Bleeding gums Bloating or swelling Blurred vision Bone pain Chest pain Chills Confusion Constipation Coughing up blood Depression Difficulty breathing Difficulty swallowing Dizziness Dry skin and hair Shortness of breath Skin rash Slowed heartbeat Sore throat Sores or ulcers on mouth Sweating Swollen glands Tightness of hands or feet Unusual bleeding or bruising Fast heartbeat Feeling cold Hair loss Headache Hives Hoarseness or husky voice Increased menstrual flow Itching Lower back or side pain Muscle cramps and stiffness Noisy breathing Painful or difficult urination Pale skin Paralysis Pinpoint red spots on the skin Prolonged bleeding from cuts Puffiness or swelling of eyelids Rapid weight gain Red or black tarry stools Red or dark brown urine Unusual weight gain or loss wheezing Trouble breathing with exertion
- 14. Acid or sour stomach Back pain Belching Body aches and pain Congestion Difficulty with moving Heartburn Indigestion Itching skin Joint pain Lack or loss of strength Loss of appetite Loose or liquid stools Muscle aches or pains Nausea Neck pain Runny nose Stomach pain Sudden sweating Swollen joints Trouble with swallowing Voice changes Vomiting Weight loss Sleepiness or drowsiness Dryness or soreness of throat Diarrhea or increased bowel movement Difficult or labored breathing Tender, swollen glands in neck SIDE EFFECTS (do not require immediate medical attention)