RITUXAN® (rituximab)

We play many roles in a given day or week — parent, sibling, caretaker, breadwinner, teacher and student. But few of us are prepared to play one of life’s toughest role — that of a patient with a serious illness. These people have stories that reflect their courage and determination in coping with their disease that inspire us all.

RITUXAN® (rituximab)

Rick Kurner

“Flying is a huge part of my life,” says Rick Kurner, age 50, who earned his first pilot’s license at age 15 and has been a commercial pilot since the mid-1980s. The Southern California native was nearly sidelined, however, when he was diagnosed in 1999 with non-Hodgkin’s lymphoma. According to Rick, many of the chemotherapies commonly used against NHL were associated with adverse effects on the peripheral nerves and heart that would prevent him from receiving medical clearance from the Federal Aviation Administration to keep flying. Fortunately, his doctor had been an investigator in clinical trials with RITUXAN® (rituximab), and suggested treatment with that therapeutic — which the FAA also authorized for Rick’s use without reservations on his ability to fly. After four infusions of RITUXAN, Rick’s tumor had shrunk by 60%, and following another eight weeks of RITUXAN therapy combined with cytoxin and prednisone, he achieved a complete remission. Rick says that he experienced no significant side effects from his RITUXAN therapy. Today, following his most recent check up in August 2003, he remains cancer-free, more than four years after treatment.

Please keep in mind that every individual experiences therapy with RITUXAN® (rituximab) differently. A patient’s own experience may be different than Rick’s.

Important Safety Information

The majority of patients experience infusion-related symptoms with their first RITUXAN infusion. These symptoms include but are not limited to, flu-like fever, chills/rigors, nausea, uticaria, headache, bronchospasm, angioedema and hypotension. These symptoms vary in severity and generally are reversible with medical intervention. In rare instances, severe and fatal infusion-related reactions have occurred, nearly all of which have been associated with the first RITUXAN infusion. These events appear as manifestations of an infusion-related complex and include hypoxia, pulmonary infiltrates, acute respiratory distress syndrome, myocardial infarction, ventricular fibrillation, cardiogenic shock and tumor lysis syndrome. Patients who develop clinically significant infusion-related cardiopulmonary events should have their RITUXAN infusion discontinued and receive medical treatment.

In rare instances, severe mucocutaneous skin reactions have occurred that may be associated with RITUXAN therapy. Many of these reactions have been described as paraneoplastic pemphigus and are known to be associated with various B-cell lymphomas, particularly NHL and CLL. Patients who develop a severe mucocutaneous skin reaction should have RITUXAN discontinued and receive appropriate medical treatment including a skin biopsy to guide therapy.

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ZEVALIN® (ibritumomab tiuxetan)

Laura Colton Tepper

Laura Colton Tepper, a paralegal at a large national law firm, was first diagnosed with low-grade non-Hodgkin’s lymphoma in 1996 at the age of 40. While her physician tried two different chemotherapy regimens against Laura’s disease, neither treatment produced a sustained response. She next participated in a clinical trial evaluating RITUXAN® (rituximab) against the experimental therapy ZEVALIN. Enrolled in the RITUXAN-only arm of the study, Laura’s disease again responded but returned immediately on cessation of treatment. Finally, she was able to participate in a second clinical study of ZEVALIN, where she received the immunotherapy. She quickly responded to treatment and now remains disease-free after more than 5 years. Laura says that while she required several transfusions following her treatment with ZEVALIN, her blood counts soon recovered and today she is enjoying a “whole new life.”

Please keep in mind that every individual experiences therapy with ZEVALIN® (Ibritumomab tiuxetan) differently. A patient’s own experience may be different than Laura’s.

Important Safety Information

ZEVALIN is not recommended for patients with platelet counts below 100,000. In safety data based upon 349 patients, the most serious adverse reactions to the ZEVALIN therapeutic regimen were primarily hematologic, with grade 4 neutropenia, thrombocytopenia, and anemia occurring in 30%, 10%, and 3% of patients treated at the 0.4 mCi/kg dose, respectively. Infusion-related toxicities were typically grade 1 or 2 and were associated with pre-administration of RITUXAN. The risk of hematologic toxicity correlated with the degree of bone marrow involvement prior to ZEVALIN therapy. Seven percent of patients were hospitalized with infection (3% of these had neutropenia), and fatal cerebral hemorrhage (less than 1%) has occurred in a minority of patients in clinical studies. Myelodysplasia or acute leukemia was observed in 1% of patients (8 to 34 months after treatment). The effects of the ZEVALIN therapeutic regimen on survival not known.

Boxed Warning Summary: ZEVALIN should only be used by health care professionals qualified by training and experience in the safe use of radionuclides. Fatal infusion reactions: rare deaths have occurred within 24 hours of RITUXAN infusions. These fatalities were associated with an infusion reaction symptom complex that included hypoxia, pulmonary infiltrates, acute respiratory distress syndrome, myocardial infarction, ventricular fibrillation, or cardiogenic shock. Prolonged and severe cytopenias: Yttrium-90 ZEVALIN administration results in severe and prolonged cytopenias in most patients.

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AVONEX® (Interferon beta-1a)

Greg Dunn

One morning in 1984, Greg Dunn woke up with a terrible, unremitting headache, extreme nausea, and blurred vision. After a week’s stay in the hospital, he returned home with no conclusion of what was wrong. He remained healthy over the next seven years and competed in the Chicago Marathon in 1990. But three months after the race, he began to feel an increasing numbness in his right hand, arm, and face, resulting in slurred speech.

Greg immediately went to see a neurologist, who after viewing his history of symptoms diagnosed him with multiple sclerosis. At that time, it felt like a death sentence, with no real treatments available and two young children at home to care for. He decided to immediately undergo an experimental intensive chemotherapy regimen in an attempt to shut down the attack.

The following year, he suffered a series of random, small attacks — never sure of when he would feel healthy again. But Greg’s future with the disease improved in 1996, when he was given the opportunity to take a new treatment, AVONEX. Since Greg has been on AVONEX, his symptoms have been minimized and he has had no additional attacks.

Two years ago, Greg fulfilled a life-long dream to be part of The Everest 2000 Environmental Expedition, a climbing team that cleans up debris left from 50 years of summit attempts. Greg and most of the group were successful in arriving at the Base Camp, at 18,000 feet, but unable to get to the top because of a team member’s illness. The local paper, the Cedar Rapids Gazette, carried daily stories of the groups’ climb, and Greg and the others were heartily welcomed back after they returned from Nepal.

In January 2003 Greg attempted to summit Mt. Kilamanjaro from the Tanzanian side. Altitude was a major obstacle in the expedition because base camp was at 6,000 feet, and the group had to climb to over 19,000 feet in just five days. Greg had been training by maintaining a regular schedule of exercise including running an average of 20 miles per week.

Throughout Greg’s illness, he has maintained a healthy body and equally important a healthy and optimistic attitude about his future. He believes that the mental component of any illness is just as important as the physical, and that it is essential that people with chronic diseases believe that they can continue to lead normal lives and look forward to their future. Greg truly believes that there are many mountains to climb ahead and views his future, and the future of others with MS as bright.

Please keep in mind that every individual experiences therapy with AVONEX® (Interferon beta-1a) differently. A patient’s own experience may be different than that of Greg.

Important Safety Information

The most common side effects associated with AVONEX treatment are flu-like symptoms including myalgia, fever, fatigue, headache, chills, nausea, vomiting, pain and asthenia.

AVONEX should be used in caution with patients with depression or other mood disorders and in patients with seizure disorders. AVONEX should not be used by pregnant women. Patients with cardiac disease should be closely monitored. Patients should also be monitored for signs of hepatic injury. Routine periodic blood chemistry and hematology tests are recommended during treatment with AVONEX. Rare cases of anaphylaxis have been reported. Please see complete prescribing information available at www.AVONEX.com .

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