Use of radioimmunotherapy in the United States of America: Opinions of nuclear physicians and radiation oncologists

Objectives Despite FDA approval and the consistent reports of efficacy and safety of 90Y-ibritumomab tiuxetan (Zevalin™) and 131I-tositumomab (Bexxar™), these therapies are rarely used. This study investigates opinions, patterns of use and aims to identify possible hurdles in the use of this promising therapy.

Methods An e-mail based survey with 13 broad questions was sent to 13,221 SNM members and radiation oncologists throughout the United States.

Results 659 individuals responded to the electronic survey with a response rate of 4.9%. 351 responders (53.3%) did treat NHL patients with RIT in the last 24 months. 27.7% only use Zevalin, 7.1% only use Bexxar and 23.2% of the responders use both radiopharmaceuticals. Most responders (31.6%) have patients who come from university hospitals or private offices (24.7%), and they do treat them in a secondline (39.9%), thirdline (33.1%) or consolidation (21.8%) setting. The major concerns are 1.) referring oncologists and hematologists want to carry out the treatment themselves with non-radioactive compounds and, 2) the high price of Zevalin and Bexxar. 26.25% of the responders think radioimmunotherapy will probably grow and 33.69% of the responders think it will grow in importance in the future. Analyses of Subgroups reveal that responders who do not administer radioimmunotherapy for NHL think it takes too much time to administer RIT (p<0.0001), have concerns about the dosimetry (p<0.0001) and the radiation safety (p<0.0001). Individuals who perceive a negative future for RIT have significantly more concerns about the time consuming administration process (p=0.012) and the high price of RIT (p=0.033). Responders from academic centers have significant fewer concerns about payment (p<0.0001), dosimetry (p<0.0001) and radiation safety (p<0.0001).

Conclusions Radioimmunotherapy was generally viewed positively by the surveyed population. However, logistic, educational and economic concerns play an important role for subgroups in the perception of RIT for NHL