Ibritumomab (Intravenous)

Overview

When non-Hodgkin's lymphoma first develops in a patient, it affects the white blood cells. However, non-Hodgkin's lymphoma is a cancer which affects the whole lymphatic system. While the disease may begin by affecting the white blood cells, it can then affect the network of glands and vessels which make up the lymphatic system.

Although there are various types of Non-Hodgkin's lymphoma, the disease can be broadly categorized as indolent or aggressive. Depending on how quickly the disease is spreading, treatment can be successful in resolving non-Hodgkin's lymphoma.

There are various treatments available for non-Hodgkin's lymphoma and each patient is likely to be treated with a number of different medicines. Ibritumomab, for example, is a monoclonal antibody radioimmunotherapy treatment and is most commonly-used to treat patients who have previously been treated with alternative medications or those who have never been treated with anti-cancer drugs.

Ibritumomab is used as a type of biological therapy and targets a protein known as CD20. As non-Hodgkin's lymphoma cells have CD20 on their surface, Ibritumomab adheres to the protein and delivers radiation to each of these cells. By doing so, Ibritumomab effectively kills the cell and helps to reduce the number of problematic cells within the patient's system and prevents them from spreading.

Often used alongside another monoclonal antibody, Rituximab, Ibritumomab is also delivered alongside a radioactive agent. Known as Yttrium or Y-90, this helps Ibritumomab to locate, adhere to and target the CD20 proteins on the surface on non-Hodgkin's lymphoma cells.

Delivered via intravenous injection, Ibritumomab can be extremely effective in treating patients with non-Hodgkin's lymphoma. Whilst monoclonal antibody treatment is newer than chemotherapy or traditional radiotherapy, it is being used to treat increasing number of patients. Based on clinical data, Ibritumomab can be used to successfully rid the body of non-Hodgkin's lymphoma cells, when it is used in conjunction with other medications.

Conditions Treated

Type Of Medicine

  • Monoclonal antibody

Side Effects

Any medication can cause the patient to experience side-effects but it's particularly common for patients to experience side-effects when they are being treated for cancer. As very strong drugs are required to treat the disease, they can cause patients to experience some unpleasant side-effects.

Often, these side-effects are more prominent when the patient is first treated with a new medicine but they may diminish over time. Although the following side-effects may not require medical intervention, patients should always seek medical help if they are concerned about the presence of any adverse effects:

  • Stomach or abdominal pain
  • Muscle stiffness or pain
  • Bruising
  • Loss of appetite
  • Constipation
  • Labored or difficult breathing
  • Large, flat purplish or blue patches in or one the skin
  • Difficulty with moving
  • Loss or lack of strength
  • Lightheadedness or faintness when getting up from a sitting or lying position
  • Joint pain
  • Fear
  • Bloated or full feeling
  • Feeling of warmth
  • Nervousness
  • Feeling of pressure in the stomach
  • Throat irritation
  • Pain
  • Redness or swelling in the joints
  • Rash on the skin
  • Stomach pain, upset or discomfort
  • Redness of the arms, neck, face, and occasionally upper chest
  • Indigestion
  • Swollen joints
  • Runny nose
  • Heartburn
  • Sleeplessness
  • Belching
  • Sneezing
  • Acid and/or sour stomach
  • Stuffy nose
  • Weight loss
  • Increased or sudden sweating
  • Inability to sleep
  • Swelling of the stomach or abdominal area
  • Trouble with sleeping
  • Swelling of the lower legs, feet, ankles or hands

Although the above side-effects may not need medical intervention, patients can still obtain advice and assistance from their physicians and nurses. In many cases, experienced practitioners can advise patients how to cope with the side-effects of Ibritumomab and how to minimize their symptoms.

However, if patients notice any of the following symptoms after receiving treatment with Ibritumomab, they should seek immediate medical help:

  • Tarry, black stools
  • Noisy breathing
  • Bleeding gums
  • Pain in lower back or side
  • Blood in the stools or urine
  • Increased vaginal bleeding or menstrual flow
  • Headache
  • Chills
  • Fever
  • Hoarseness
  • Cough
  • Trouble breathing
  • Coughing up blood
  • Trouble swallowing
  • Dizziness
  • Swollen glands
  • Large, hive-like swelling on the lips, eyelids, throat, tongue, feet, legs, hands, face or sex organs
  • Red stools
  • Nosebleeds
  • Sore throat
  • Difficult or painful urination
  • Dark brown or red urine
  • Pale skin
  • Shortness of breath
  • Paralysis
  • Red, pinpoint spots on the skin
  • Prolonged bleeding from cuts
  • Wheezing
  • Chest tightness
  • Hives
  • White spots, ulcers or sores in the mouth or on the lips
  • Itching
  • Bluish skin or lips
  • Fainting
  • Troubled breathing with exertion
  • Chest discomfort or pain
  • Unusual bruising or bleeding
  • Confusion
  • Bloody nose that does not stop after pinching the nose together and holding it for approximately 5 to 10 minutes
  • Lightheadedness
  • Diarrhea
  • Unusual weakness or tiredness
  • Fast heartbeat
  • Swelling or puffiness around the eyes or of the eyelids, lips, tongue or face
  • Anxiety
  • Shallow, rapid breathing
  • Agitation
  • Rash on the skin
  • Vomiting material that looks like coffee grounds
  • Small purple or red spots on the skin
  • Vomiting blood
  • Unusual vaginal bleeding
  • Back pain
  • Nausea
  • Hives, inflammation, infection, lumps, itching, pain, stinging or numbness at site of injection
  • Blurred vision
  • Blistering, bleeding, coldness, burning, feeling of pressure or redness at the site of injection
  • Coma
  • Scarring, rash, soreness, tenderness, tingling, swelling or skin discoloration at site of injection
  • Drowsiness
  • Inability to speak
  • Pounding, irregular or fast pulse or heartbeat
  • Hallucinations
  • Skin blisters
  • Irritability
  • Scaly skin
  • Mood or mental changes
  • Swollen, red skin
  • Irritated, red eyes
  • Redness of the skin
  • Loss of heat from the body
  • Red skin lesions, sometimes with a purple center
  • Muscle or joint pain
  • Seizures
  • Cracks in the skin
  • Severe headache
  • Vomiting
  • Loosening, peeling or blistering of the skin
  • Slurred speech
  • Welts
  • Stiff neck
  • Weakness in the leg or arm on one side of the body, may be severe and/or sudden
  • Temporary blindness

Whilst the above side-effects do not necessarily mean that Ibritumomab is failing to work, they do warrant medical attention.

As well as experiencing side-effects immediately after treatment with Ibritumomab, patients may suffer from adverse effects for quite some time after their treatment is complete. During this time, patients should have regular consultations with their physician so that their medical health and side-effects can be monitored. However, if patients experience any of the follow side-effects during the weeks or months after treatment with Ibritumomab, they should obtain immediate medical help:

  • Bleeding gums
  • Temporary blindness
  • Bone pain
  • Dark brown or red urine
  • Increased vaginal bleeding or menstrual flow
  • Headache, sudden and severe
  • Tarry, black or red stools
  • Inability to speak

In addition to this, patients should obtain medical assistance if they experience any other side-effects which are not listed above.

Dosage

Before being treated with Ibritumomab, patients are often given Rituximab for a period of one week. An intravenous injection of Ibritumomab is then administered to the patient. Although the patient's dose of Ibritumomab varies, they are usually given just one Ibritumomab injection.

When calculating the patient's dose of Ibritumomab, various factors are taken into account. Their condition, their medical history, their age, weight and platelet count are all assessed in order to determine the appropriate dose, for example.

As Ibritumomab is delivered intravenously, it can be administered fairly quickly. In most cases, an Ibritumomab injection takes approximately ten minutes. As the medication is given by a qualified healthcare practitioner, patients will not have to calculate their own dose of Ibritumomab or administer the medication themselves.

Potential Drug Interactions

Before being treated with Ibritumomab, patients should tell their physician if they are taking or using any other medicines, supplements and/or vitamins. As some drugs interact with one another, it may not be safe for patients to take certain other medications whilst they are being treated with Ibritumomab.

Similarly, patients should obtain medical advice before using any new medicines, supplements or vitamins once they have started treatment for non-Hodgkin's lymphoma.

Warnings

If the patient has any existing health problems or a medical history of certain conditions, it may affect the use of Ibritumomab. The following conditions, in particular, can affect the safety and efficacy of treatment with Ibritumomab:

Currently, studies have not shown whether Ibritumomab presents different risks when used in pediatric patients. Due to this, young patients, children and/or infants may not be prescribed Ibritumomab.

Before beginning treatment with Ibritumomab, physicians should discuss the risks associated with the medication with the patient. As serious side-effects can occur as a result of treatment, patients will need to be aware of how the medicine could affect them.

Ibritumomab can cause patients to suffer a serious side-effect, known as an infusion reaction. This requires immediate medical treatment and can be life-threatening. Patients should obtain urgent medical assistance if they experience the following side-effects after being treated with Ibritumomab:

  • Chills
  • Fever
  • Chest tightness
  • Difficulty breathing
  • Lightheadedness
  • Fainting
  • Swelling of the hands and/or face

On occasion, patients may experience a serious skin reaction after being treated with Ibritumomab. If patients experience the following side-effects after treatment, they should obtain urgent medical assistance:

  • Loosening, peeling or blistering of the skin
  • Swollen, irritated, scaly or red skin
  • Chills
  • Fever
  • Diarrhea
  • Headache

During and following treatment with Ibritumomab, patients should not have any vaccinations or immunizations without their doctor's express approval. As Ibritumomab can affect the body's immune system and resistance, the patient could develop the infection the immunization is trying to prevent, if a live vaccine is used.

Whilst being treated with Ibritumomab, patients may have fewer white blood cells than normal and lower levels of platelets in the blood. This can make them particularly prone to contracting infections and experiencing unusual bleeding or bruising.

Patients should, therefore, stay away from people who are unwell and should seek immediate medical help if they begin to experience any symptoms of illness. In addition to this, patients should take steps to avoid bruising, bleeding or other injuries. Patients should take extra care when brushing their teeth or flossing, for example, in order to prevent their gums from bleeding.

When Ibritumomab is administered, the medicine should go directly into the patient's vein. If it leaks out and comes into contact with the surrounding tissue, it may cause damage and/or scarring. Patients should inform a healthcare practitioner immediately if they notice the medicine is leaking onto the surrounding skin.

Whilst being treated with Ibritumomab, patients will be exposed to radiation. Although this can help to treat cancer, it does carry certain risks. Patients should discuss these risks with their doctor prior to treatment.

Ibritumomab contains albumin which have been obtained from human blood. Although blood donors are subject to testing prior to making a donation and blood is tested following the donation, there is a risk that patients could contract a virus that the blood donor has. If patients are concerned about this possibility, they should discuss the potential risks with their physician.

If Ibritumomab is prescribed to patients who are pregnant, it may cause harm to their unborn baby. Due to this high risks associated with Ibritumomab, patients should use effective birth control whilst being treated with Ibritumomab and for at least twelve months after they have completed their treatment.

Patients should not become pregnant or father a child whilst receiving treatment with Ibritumomab or for at least twelve months after treatment. If patients become pregnant or impregnate a partner during this time, they must notify their doctor immediately.

When patients breastfeed, any medication they are taking or using can be passed on the infant. It is not known whether Ibritumomab can be transferred to an infant in this way but, due to the risks involved, patients are advised not to breastfeed whilst being treated with Ibritumomab or for some time after completing their treatment. Patients should obtain medical advice before breastfeeding if they have been treated with Ibritumomab, even if their treatment occurred some time ago.

Before using Ibritumomab, patients should inform their doctor if they have any known allergies. If patients experience any allergic reaction whilst being treated with Ibritumomab, they will need emergency medical treatment. An allergic reaction may include the following symptoms:

  • Wheezing
  • Difficulty swallowing
  • Difficulty breathing
  • Itching
  • Rash on the skin
  • Hoarseness
  • Hives
  • Swelling of the face, lips, tongue, throat, mouth and/or hands

Storage

Normally supplied as treatment kits, Ibritumomab should be kept in accordance with the manufacturer's guidelines. In most cases, however, the kits should be kept between temperatures of 2?-8?C (36?-46?F) and should not be frozen.

As Ibritumomab is only administered by a qualified healthcare professional, the medication will be stored in a secure, clinical setting. Due to this, patients will not have to store Ibritumomab at home.

Summary

Although treatment with Ibritumomab is associated with a number of side-effects, it can provide effective treatment for patients with non-Hodgkin's lymphoma. Whilst the risks of Ibritumomab treatment should be addressed prior to treatment, the benefits of using this medication often outweigh the possible harm it can cause.

With regular monitoring, blood tests and continual assessment, physicians can respond to the patient's condition as needed. If patients experience any adverse effects, for example, careful monitoring can ensure that medical intervention takes place as quickly as possible.

When used in conjunction with Rituximab and Y-90, Ibritumomab can, therefore, be used to successfully treat patients who have been diagnosed with non-Hodgkin's lymphoma and who have yet to receive treatment or have failed to respond to previous therapies.