Bexxar and NHL
This page is about the drug called Bexxar, and how it may be used for non Hodgkin's lymphoma. There is information about
Bexxar is a new type of cancer treatment. It is a special type of monoclonal antibody. Bexxar is also called tositumomab (pronounced toss-ee-too-mo-mab). It belongs to a group of medicines called biological therapies. Bexxar is made up of two parts. It has a monoclonal antibody (tositumomab) part and a radioactive part. This type of drug is known as a radiolabelled monoclonal antibody. Researchers are looking into Bexxar as a treatment for certain types of non Hodgkins lymphoma (NHL). Bexxar is not yet available in the UK but you may have it as part of a clinical trial.
Bexxar is used to treat some B cell lymphomas. Normal B cells and the lymphoma cells have a protein called CD20 on their surface. Bexxar targets and sticks to the CD20 protein on the cells. The radioactive part is called iodine 131 (I-131) and kills the cells with radiation. The monoclonal antibody part makes the immune system help to destroy the lymphoma cells. Some normal B cells will be affected as well but your body can replace them.
Bexxar is only available as part of clinical trials in the UK. In certain circumstances you may have Bexxar if your doctor thinks it is suitable for you. You may have Bexxar in the following situations
- When rituximab is no longer working
- If NHL has come back after treatment
- As a first treatment for NHL
You have Bexxar in a hospital that has a nuclear medicine department. You have Bexxar through a drip into a vein (intravenous infusion). Your treatment is in two parts. At your first appointment, your doctor will scan you and you will have a small dose of Bexxar. This helps them to work out the dose you need. You then go back for two more scans, about 2 days apart. The scans are for your doctor to check that the dose was right for you and the treatment has spread around your body properly.
You have your second dose of Bexxar between 7 and 14 days after your first dose. Your second dose is when the actual treatment begins. This is called the therapeutic dose.
To stop you reacting to the infusion you have steroids and antihistamines before your treatment. You will have the steroids and antihistamines through your drip.
Before any of your treatment begins you will take a drug to protect your thyroid gland. This is to stop you developing low thyroid hormone levels hypothyroidism. Iodine can stop your thyroid gland working properly. You can take this drug as tablets or as a liquid. You start this drug the day before your Bexxar treatment begins. And you continue to take the thyroid drug for 14 days after you had your therapeutic dose of Bexxar.
Bexxar treatment makes you slightly radioactive for a few days, and you may need to stay in hospital in a single room.Your visitors will only be able to visit for an hour or two a day. Your radiation levels will drop within a few days and you can then go home. The risk to other people is small. But children and pregnant women should not visit you for two weeks after treatment. Your nurse will tell you about any special precautions you need to take when you go home.
Bexxar is a new drug and we are still finding out about its side effects. People who took part in Bexxar trials had the following side effects
- Infection in 25 out of every 100 people (25%) ̶̶ you have an increased risk of getting an infection from a drop in white blood cells (neutropenia). Infections can sometimes be life threatening.You should urgently contact your doctor if you think you have an infection
- Bruising more easily due to a drop in platelets ̶̶ 20 out of every 100 people (20%) had bruising
- Tiredness in 43 out of every 100 people (43%) ̶̶ you can become anaemic during Bexxar treatment. Low red blood cells and haemoglobin will make you feel tired and short of breath
- Feeling sick in 25 out of every 100 people (25%)
- Loss of appetite in 10 out of every 100 people (10%)
- Itching in 13 out of every 100 people (13%)
- Low blood pressure in 10 out of every 100 people (10%)
- Shortness of breath in some people
People also had allergic reactions to the Bexxar drip. The symptoms of a reaction include a high temperature (fever) and chills. 2 out of every 100 people (2%) had wheezing and a stuffy nose (nasal congestion) due to a reaction. The reaction can also cause very low blood pressure. But your doctor is aware of these reactions and can treat them if they happen.
Bexxar is new and it is yet not known if it affects a person's fertility. If you are considering having children in the future you should discuss this with your doctor before you start your treatment.
8 out of 100 people (8%) who had Bexxar after chemotherapy treatment developed a myelodysplastic syndrome or acute leukaemia. Other trials have not shown this side effect, but we need more research to find out how often it happens.
Bexxar can affect your immune system. You should not be vaccinated during or after treatment without checking with your doctor first.
Remember Bexxar may react with some other medicines. Even ones you can buy from the chemist. Remember to ask your doctor before taking any new medicines.
Researchers have been looking at how well Bexxar works. They also want to know what is the best dose and when it is best to have this treatment. One trial was for people who had had chemotherapy before. Researchers wanted to see how Bexxar compared with the last chemotherapy the person had. The results showed that Bexxar worked better. 20 out of 100 people (20%) showed no signs of the lymphoma (a complete response) after Bexxar treatment. Only 3 out of 100 (3%) had a complete response to chemotherapy.
Researchers have also looked at how well Bexxar works for people whose lymphoma came back (relapsed), either during or after having the biological therapy rituximab. They found that the lymphoma shrank in 70 out of 100 people (70%). And the lymphoma went away completely in 32 out of 100 people (32%).
Another trial looked at Bexxar as a first treatment for B cell lymphoma. It found that the lymphoma shrank in nearly all of the people having Bexxar. The lymphoma went away completely in 63 out of 100 people (63%) after treatment with Bexxar.
These results are promising, but they are early trials and we need more research to
- Confirm that Bexxar works for lymphoma
- See how long it gets rid of the lymphoma for
- Work out when it is best to have this treatment
- Find out more about the side effects
You can find more information about treating non Hodgkin’s lymphoma in the non Hodgkin’s lymphoma section. And you can search for UK clinical trials for NHL on our clinical trials database. Choose ‘lymphoma’ from the list of cancer types.
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