Ibritumomab Tiuxetan Radioimmunotherapy Improves Quality of Life in Patients With Low-Grade, Follicular, or Transformed Non-Hodgkin’s Lymphoma

The impact of anticancer therapy on quality of life has beenreceiving increasing attention, particularly with diseases such as low-gradenon-Hodgkin’s lymphoma (NHL), where palliation rather than cure is the primaryobjective of therapy. The Functional Assessment of Cancer Therapy-General(FACT-G) is a validated questionnaire that captures the major areas of patients’subjective evaluation of the impact of their cancer on the following domains:physical, social, emotional, functional, and relationship with doctor (J ClinOncol 11[3]:570-579, 1993). There are two to seven questions per domain,yielding a total score from 0 to 112.

We used the FACT-G survey to assess quality of life in a phaseIII randomized trial of ibritumomab tiuxetan (Zevalin) radioimmunotherapy vsrituximab (Rituxan) immunotherapy in patients with relapsed or refractorylow-grade, follicular, or transformed NHL. The phase III trial enrolled 73patients on the ibritumomab tiuxetan arm and 70 patientson the rituximab arm, with the following baseline characteristics: median age,59 years (range: 29 to 80 years); 51% female; largest tumor > 5 cm, 45%; bonemarrow involvement, 39%; and International Prognostic Index intermediate/high or high-riskgroup, 12%.

FACT-G total scores and subscale scores were compared betweenbaseline and 3 months posttherapy within each of the treatment arms. Threemonths was chosen because patients were most likely to be in a maximal responsefrom either therapy at this point. Not all patients completed thequestionnaires; 62% and 51% of patients on the ibritumomab tiuxetan andrituximab arms, respectively, completed both a baseline and a 3-month FACT-Gsurvey.

Of note, the mean baseline FACT-G score, prior to treatment, washigh in both treatment arms: 86.9 for ibritumomab tiuxetan and 90.7 forrituximab. At 3 months posttherapy, the ibritumomab tiuxetan group experienced astatistically significant increase in the FACT-G total score (86.9 to 93.3; P =.001); the increase for the rituximab arm was not statistically significant(90.7 to 93.4; P = .185). Patients on the ibritumomab tiuxetan arm alsoexperienced statistically significant improvement in the following FACT-Gsubscales: emotional, physical, and functional well-being; the rituximab groupexperienced a statistically significant improvement in the emotional subscale.

CONCLUSION: Ibritumomab tiuxetan therapy results in astatistically significant improvement in patient self-assessed quality of life.Such information may help patients and physicians with their treatmentdecisions.

Click here to read Dr. Bruce Cheson's commentary on this abstract.