Zevalin
Zevalin
(ibritumomab tiuxetan) Injection for Intravenous use
SERIOUS INFUSION REACTIONS, PROLONGED AND SEVERE CYTOPENIAS, and SEVERE CUTANEOUS AND MUCOCUTANEOUS REACTIONS
Serious Infusion Reactions: Deaths have occurred within 24 hours of rituximab infusion, an essential component of the Zevalin therapeutic regimen. These fatalities were associated with hypoxia, pulmonary infiltrates, acute respiratory distress syndrome, myocardial infarction, ventricular fibrillation, or cardiogenic shock. Most (80%) fatalities occurred with the first rituximab infusion [see WARNINGS and PRECAUTIONS and ADVERSE REACTIONS]. Discontinue rituximab, In-111 Zevalin, and Y-90 Zevalin infusions in patients who develop severe infusion reactions.
Prolonged and Severe Cytopenias: Y-90 Zevalin administration results in severe and prolonged cytopenias in most patients. Do not administer the Zevalin therapeutic regimen to patients with ≥25% lymphoma marrow involvement and/or impaired bone marrow reserve [see WARNINGS and PRECAUTIONS and ADVERSE REACTIONS].
Severe Cutaneous and Mucocutaneous Reactions: Severe cutaneous and mucocutaneous reactions, some fatal, can occur with the Zevalin therapeutic regimen. Discontinue rituximab, In-111 Zevalin, and Y-90 Zevalin infusions in patients experiencing severe cutaneous or mucocutaneous reactions [see WARNINGS and PRECAUTIONS and ADVERSE REACTIONS].
Dosing: The dose of Y-90 Zevalin should not exceed 32.0 mCi (1184 MBq). Do not administer Y-90 Zevalin to patients with altered biodistribution as determined by imaging with In-111 Zevalin [see DOSAGE AND ADMINISTRATION].
DRUG DESCRIPTION
Zevalin(ibritumomab tiuxetan)isthe immunoconjugate resulting from a stable thiourea covalent bond between the monoclonal antibody ibritumomab and the linker-chelator tiuxetan [N-[2-bis(carboxymethyl)amino]-3- (p-isothiocyanatophenyl)-propyl]-[N-[2-bis(carboxymethyl)amino]-2- (methyl)-ethyl]glycine. This linker-chelator provides a high affinity, conformationally restricted chelation site for Indium-111 or Yttrium-90. The approximate molecular weight of ibritumomab tiuxetan is 148 kD. The antibody moiety of Zevalin is ibritumomab, a murine IgG1 kappa monoclonal antibody directed against the CD20 antigen.
Ibritumomab tiuxetan is a clear, colorless, sterile, pyrogen-free, preservative-free solution that may contain translucent particles. Each single-use vial includes 3.2 mg of ibritumomab tiuxetan in 2mL of 0.9% Sodium Chloride.
Physical/Radiochemical Characteristics of In-111
Indium-111 decays by electron capture, with a physical half-life of 67.3 hours (2.81 days). The product of radioactive decay is non-radioactive Cadmium-111. Radiation emission data for In-111 are summarized in Table 4.
Table 4. Principal In-111 Radiation Emission Data
| Radiation | Mean % per Disintegration | Mean Energy (keV) |
| Gamma-2 | 90.2 | 171.3 |
| Gamma-3 | 94.0 | 245.4 |
External Radiation
The exposure rate constant for 1 mCi (37 MBq) of In-111 is 8.3 x 10-4 C/kg/hr (3.2 R/hr) at 1 cm.
To allow correction for physical decay of In-111, the fractions that remain at selected intervals before and after the time of calibration are shown in Table 5.
Table 5. Physical Decay Chart: In-111 Half-life 2.81 Days
(67.3 Hours)
| Calibration Time (Hrs.) | Fraction Remaining |
| -48 | 1.64 |
| -42 | 1.54 |
| -36 | 1.45 |
| -24 | 1.28 |
| -12 | 1.13 |
| -6 | 1.06 |
| 0 | 1.00 |
| 6 | 0.94 |
| 12 | 0.88 |
| 24 | 0.78 |
| 36 | 0.69 |
| 42 | 0.65 |
| 48 | 0.61 |
Physical/Radiochemical Characteristics of Y-90
Yttrium-90 decays by emission of beta particles, with a physical half-life of 64.1 hours (2.67 days). The product of radioactive decay is non-radioactive Zirconium-90. The range of beta particles in soft tissue(χ90) is 5 mm. Radiation emission data for Y-90 are summarized in Table 6.
Table 6. Principal Y-90 Radiation Emission Data
| Radiation | Mean % per Disintegration | Mean Energy (keV) |
| Beta minus | 100 | 750-935 |
External Radiation
The exposure rate for 1 mCi (37 MBq) of Y-90 is 8.3 x 10-3 C/kg/hr (32 R/hr) at the mouth< of an open Y-90 vial.
To allow correction for physical decay of Y-90, the fractions that remain at selected intervals before and after the time of calibration are shown in Table 7.
Table 7. Physical Decay Chart: Y-90 Half-life 2.67 Days (64.1
Hours)
| Calibration Time (Hrs.) | Fraction Remaining | Calibration Time (Hrs.) | Fraction Remaining |
| -36 | 1.48 | 0 | 1.00 |
| -24 | 1.30 | 1 | 0.99 |
| -12 | 1.14 | 2 | 0.98 |
| -8 | 1.09 | 3 | 0.97 |
| -7 | 1.08 | 4 | 0.96 |
| -6 | 1.07 | 5 | 0.95 |
| -5 | 1.06 | 6 | 0.94 |
| -4 | 1.04 | 7 | 0.93 |
| -3 | 1.03 | 8 | 0.92 |
| -2 | 1.02 | 12 | 0.88 |
| -1 | 1.01 | 24 | 0.77 |
| 0 | 1.00 | 36 | 0.68 |
Generic Name: Ibritumomab Tiuxetan
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