90Y-Ibritumomab tiuxetan (Zevalin ®)
90Y-Ibritumomab tiuxetan, also known as Zevalin ®, is used to treat people with a type of non-Hodgkin lymphoma called follicular lymphoma. Zevalin may also be used to treat other types of cancer as part of a research trial.
This section describes Zevalin, how it's given and some of its possible side effects. It should ideally be read with our general information about non-Hodgkin lymphoma and rituximab (Mabthera ®).
You'll see your doctor regularly while you have this treatment so they can monitor its effects. This information should help you discuss any queries about your treatment and its side effects with your doctor or specialist nurse.
Zevalin belongs to a group of cancer drugs known as monoclonal antibodies. Monoclonal antibodies are sometimes called targeted therapies, because they work by ‘targeting’ specific proteins (receptors) on the surface of cells.
Zevalin is a type of monoclonal antibody known as a radiolabelled monoclonal antibody. It's made up of a monoclonal antibody (Ibritumomab tiuxetan) with a radioactive substance (Yttrium-90, or 90Y) attached to it. The radiation from 90Y can destroy cancer cells. It can also affect normal cells.
Zevalin locks on to a protein called CD20, which is present on the surface of a type of white blood cell called B-lymphocytes (B-cells). CD20 is present both on normal B-cells and on abnormal (malignant) B-cells, found in many types of non-Hodgkin lymphoma.
When Zevalin locks on to the B-cells, it delivers radiation that damages or kills them. Both normal and abnormal B-cells are killed, but the body can replace the normal white blood cells that are damaged.
Zevalin is licensed as a treatment for people who have follicular lymphoma that has come back after treatment with rituximab or that hasn't responded to rituximab. It may also be given to people who are in remission from follicular lymphoma - this means there’s no sign of lymphoma after their first treatment. This type of treatment is called consolidation therapy.
The National Institute for Health and Clinical Excellence (NICE) currently gives advice on which new drugs or treatments should be available for use in the NHS in England and Wales. They have not yet assessed the use of Zevalin.
Recommendations on the use of new drugs within the NHS in Scotland are made by the Scottish Medicines Consortium (SMC). The SMC doesn’t currently recommend the use of Zevalin.
As a result, Zevalin may not be widely available on the NHS, although you may be given it as part of a clinical trial. We have more information about what you can do if a treatment isn't available.
Zevalin can only be given in hospitals with appropriate specialist facilities, so you may need to travel to another hospital for treatment.
Zevalin is given as a one-off treatment and not as repeated courses of treatment. It consists of two parts, given approximately one week apart:
Rituximab is given on the first day of treatment to reduce the number of normal B-cells. This is to reduce the effects of Zevalin on healthy, non-cancerous cells. About one week later, you'll have a second infusion of rituximab. Within four hours of this infusion, you'll go to the nuclear medicine or radiotherapy department to have the Zevalin. This is given by drip into a vein (called an intravenous infusion) and takes about 10 minutes.
Possible side effects of Zevalin
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Each person's reaction to treatment is different. Some people have very few side effects, while others may experience more. The side effects described here will not affect everyone who has this treatment.
We have outlined the most common side effects as well as the less common ones, so that you can be aware of them if they occur. However, we haven't included those that are very rare and therefore unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor or nurse.
Most side effects of Zevalin fall into two groups:
side effects that may occur during the infusion or shortly afterwards (infusion-related reactions)
side effects that may occur days or weeks later.
While receiving Zevalin or rituximab, some people have a reaction to the treatment. You'll be given drugs before the infusion to reduce the chances of this. If you have a reaction it can usually be treated by slowing down or stopping the drip until you feel better. Sometimes additional medicines may also be given.
You'll be monitored closely during the infusion, but tell your nurse or doctor immediately if you feel unwell or have any of the following symptoms:
flu-like symptoms, including feeling flushed, having a fever, chills, dizziness, headaches or joint and muscle pains
red, warm, itchy bumps on your skin (like nettle rash)
a feeling of swelling in the lips, tongue or throat
breathlessness, wheezing, a cough or sudden difficulty in breathing
pain in your back or tummy
a tight chest or chest pain.
Rarely, an infusion-reaction can occur a few hours after treatment. If you develop these symptoms or feel unwell after you get home, contact the hospital straight away for advice.
Side effects following treatment with Zevalin
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Risk of infection
Zevalin can reduce the number of white blood cells, which help the body fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low, you will be more prone to infections. A low white blood cell count is called neutropenia. This may continue for a few weeks after treatment.
Contact your doctor or the hospital straight away if:
your temperature goes above 38°C (100.4°F)
you suddenly feel unwell, even with a normal temperature.
Your doctors will check your blood levels regularly during treatment and as part of your follow-up.
Bruising and bleeding
Zevalin can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You can have a platelet transfusion if your platelet count is low.
Anaemia (low number of red blood cells)
Zevalin can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Feeling sick (nausea) and being sick (vomiting)
Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea or vomiting. If the sickness isn't controlled, or if it continues, tell your doctor. They can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Zevalin can cause diarrhoea. This can usually be easily controlled with medicine, but tell your doctor if it is severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Dizziness and headaches
Some people notice an increase in headaches or have episodes of dizziness for a few weeks after treatment with Zevalin. Tell your doctor or nurse if you're affected. It’s important not to drive if you feel dizzy.
You may get constipated. This can usually be helped by drinking plenty of fluids, eating more fibre in your diet and doing some gentle exercise. You may need to take medicine (laxatives) to help. Your doctor can prescribe these, or you can buy them from a pharmacy.
This is usually mild but it may be itchy. It's important to tell your nurse or doctor if you develop a rash. They can advise you on what can help.
It's important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they're not mentioned above.
Additional information about Zevelin
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Precautions are needed after treatment with Zevalin, because radiation can remain in the body and bodily fluids for a short time afterwards. This includes the blood, stools, urine, saliva, vaginal fluid and semen.
For seven days after therapy, you should avoid transfer of body fluids to other people. It's important to wash your hands thoroughly after going to the toilet and clearing up any spills. You should also use a condom during sex. All of this will help minimise exposure to radiation for those close to you. Pregnancy should be avoided for one year after treatment.
You should avoid having live vaccines during treatment and for at least one year afterwards. Live vaccines include BCG, yellow fever, measles, mumps, rubella, liquid typhoid, poliomyelitis liquid and MMR.
Some medicines should only be used under the supervision of your doctor while you have Zevalin treatment. This includes blood thinners (anti-coagulants) and drugs such as aspirin and ibuprofen.
Some other medicines, including those you can buy from a shop or pharmacy, can be harmful to take when you’re having Zevalin. Tell your doctor about any medicines you’re taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
It's not advisable to become pregnant or father a child during treatment with Zevalin or for one year afterwards. This is because it may harm the developing baby. It's important to use effective contraception during treatment. You can discuss this with your doctor.
There is a potential risk that Zevalin may be present in breast milk, so women are advised not to breastfeed during treatment and for one year afterwards.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you’re having Zevalin treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. During office hours you can contact the clinic or ward where you had your treatment. Your specialist nurse or doctor will tell you who to contact during the evening or at weekends.
This information has been compiled using information from a number of reliable sources, including:
171/05 - Ibritumomab tiuxetan 1.6mg/ml (Zevalin). Scottish Medicines Consortium (SMC). July 2005.
499/08 - Ibritumomab tiuxetan 1.6mg/ml (Zevalin). Scottish Medicines Consortium (SMC). August 2008.
electronic Medicines Compendium (eMC) (accessed October 2012).
With thanks to Dermot Ball, Cancer Network Pharmacist, and the people affected by cancer who reviewed this edition. Reviewing information is just one way you could help when you join our Cancer Voices network.