Tositumomab

What is Tositumomab

The tositumomab therapeutic regimen uses radioimmunotherapy in a 2-step approach that combines a radionuclide and monoclonal antibody for the treatment of non-Hodgkin’s lymphoma (NHL).

Tositumomab is a murine IgG2a gamma monoclonal anti-CD20 antibody. The CD20 antigen (human B-lymphocyte-restricted differentiation antigen, Bp-35) is a hydrophobic transmembrane protein located on normal and malignant pre-B and mature B lymphocytes and established B-cell lines.

The CD20 antigen is expressed on > 90% of B-cell NHL but is not found on other hematopoietic stem cells, pro-B cells, normal plasma cells, or other normal tissues. Iodine I-131 tositumomab is a radio-iodinated derivative of tositumomab that has been covalently linked to iodine I-131.

Tositumomab was FDA-approved in June 2003. However, it was withdrawn from the market in the United States and Canada by the manufacturer (GlaxoSmithKline) in February 2014 due to declining sales.

Brand Name

Bexxar

Indications

  • non-Hodgkin’s lymphoma (NHL)
  • stem cell transplant preparation

Side Effects

  1. abdominal pain
  2. anaphylactoid reactions
  3. anemia
  4. angioedema
  5. anorexia
  6. antibody formation
  7. arthralgia
  8. asthenia
  9. back pain
  10. bleeding
  11. bronchospasm
  12. chest pain (unspecified)
  13. chills
  14. constipation
  15. cough
  16. diaphoresis
  17. diarrhea
  18. dizziness
  19. drowsiness
  20. dyspepsia
  21. dyspnea
  22. fever
  23. headache
  24. hyperhidrosis
  25. hypotension
  26. hypothyroidism
  27. infection
  28. infusion-related reactions
  29. injection site reaction
  30. myalgia
  31. nausea
  32. neutropenia
  33. new primary malignancy
  34. paresis
  35. peripheral edema
  36. peripheral vasodilation
  37. pharyngitis
  38. pruritus
  39. rash
  40. rhinitis
  41. serum sickness
  42. thrombocytopenia
  43. vomiting
  44. weight loss

Monitoring Parameters

  • CBC with differential
  • serum creatinine
  • thyroid function tests (TFTs)

Contraindications

  • accidental exposure
  • anticoagulant therapy
  • bone marrow suppression
  • breast-feeding
  • chemotherapy
  • children
  • coagulopathy
  • dental disease
  • dental work
  • fungal infection
  • geriatric
  • herpes infection
  • hypothyroidism
  • infection
  • infertility
  • intramuscular injections
  • iodine hypersensitivity
  • male-mediated teratogenicity
  • neutropenia
  • pregnancy
  • radiation exposure
  • renal failure
  • renal impairment
  • requires an experienced clinician
  • thrombocytopenia
  • thyroid disease
  • urinary tract obstruction
  • vaccination
  • varicella
  • viral infection

Interactions

  • Alpha interferons
  • Amlodipine; Celecoxib
  • Antithymocyte Globulin
  • Azelastine; Fluticasone
  • Beclomethasone
  • Betamethasone
  • Budesonide
  • Budesonide; Formoterol
  • Celecoxib
  • Ciclesonide
  • Clozapine
  • Corticosteroids
  • Corticotropin, ACTH
  • Cortisone
  • Deflazacort
  • Dexamethasone
  • Diclofenac
  • Diclofenac; Misoprostol
  • Diflunisal
  • Digoxin
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Echinacea
  • Esomeprazole; Naproxen
  • Etodolac
  • Famotidine; Ibuprofen
  • Fenoprofen
  • Filgrastim, G-CSF
  • Fludrocortisone
  • Flunisolide
  • Flurbiprofen
  • Fluticasone
  • Fluticasone; Salmeterol
  • Fluticasone; Umeclidinium; Vilanterol
  • Fluticasone; Vilanterol
  • Formoterol; Mometasone
  • Hydrocodone; Ibuprofen
  • Hydrocortisone
  • Ibuprofen
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Indomethacin
  • Interferon Alfa-2a
  • Interferon Alfa-2b
  • Interferon Alfa-2b; Ribavirin
  • Interferon Alfa-n3
  • Interferon Alfacon-1
  • Ketoprofen
  • Ketorolac
  • Lansoprazole; Naproxen
  • Live Vaccines
  • Meclofenamate Sodium
  • Mefenamic Acid
  • Meloxicam
  • Methylprednisolone
  • Mometasone
  • Nabumetone
  • Naproxen
  • Naproxen; Pseudoephedrine
  • Naproxen; Sumatriptan
  • Nonsteroidal antiinflammatory drugs
  • Oxaprozin
  • Palifermin
  • Pegfilgrastim
  • Peginterferon Alfa-2a
  • Peginterferon Alfa-2b
  • Penicillamine
  • Piroxicam
  • Prednisolone
  • Prednisone
  • Rofecoxib
  • Sulindac
  • Tbo-Filgrastim
  • Tolmetin
  • Triamcinolone
  • Tuberculin Purified Protein Derivative, PPD
  • Valdecoxib
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