Common brand names

• Gazyva

How it is administered

Obinutuzumab is given as an intravenous (IV) infusion, meaning it is delivered directly into your vein by a healthcare professional. It is not given as a quick injection (IV push or bolus), but rather as a slow drip over several hours. The medication comes in a liquid form and is diluted before being administered.

For follicular lymphoma, the typical schedule is:

• 1,000 mg on days 1, 8, and 15 of the first cycle (Cycle 1)
• 1,000 mg on day 1 of subsequent cycles (Cycles 2-6 or 2-8, depending on your chemotherapy regimen)
• After initial treatment, if you respond well, you may continue to receive 1,000 mg every two months for up to two years as maintenance therapy.

Premedication with steroids, acetaminophen, and antihistamines is recommended before each infusion to help reduce the risk of infusion-related reactions.

How it works

Obinutuzumab is a type of medicine called a monoclonal antibody. It is designed to target a specific protein called CD20, which is found on the surface of certain B cells (a type of white blood cell). In follicular lymphoma and other blood cancers, these B cells become cancerous and multiply uncontrollably.

When obinutuzumab attaches to the CD20 protein on these cells, it helps your immune system recognize and destroy them. It does this in several ways:

• It recruits other immune cells to attack the cancerous B cells (antibody-dependent cellular cytotoxicity and phagocytosis).
• It can directly trigger the cancer cell to die (direct cell death).
• It activates the complement system, a part of your immune system that helps clear out damaged cells.

By reducing the number of abnormal B cells, obinutuzumab helps control the lymphoma and can lead to remission or longer periods without disease progression.

Who should take it

Obinutuzumab is used to treat adults with follicular lymphoma in two main situations:

• For patients whose follicular lymphoma has returned (relapsed) or did not respond (is refractory) to previous treatment with a rituximab-containing regimen, obinutuzumab is given in combination with bendamustine, followed by obinutuzumab alone as maintenance therapy.
• For adults with previously untreated stage II bulky, III, or IV follicular lymphoma, obinutuzumab is given in combination with chemotherapy (such as bendamustine, CHOP, or CVP), followed by obinutuzumab alone if the patient achieves at least a partial remission.

Your doctor will determine if obinutuzumab is right for you based on your type and stage of lymphoma, your previous treatments, and your overall health.

Who should not take it

You should not take obinutuzumab if you have had a severe allergic reaction (anaphylaxis), serum sickness, or other hypersensitivity to obinutuzumab or any of its ingredients.

Obinutuzumab should not be given to patients with active infections. If you have a history of recurring or chronic infections, your doctor will carefully consider the risks and benefits. It is also important to avoid live virus vaccines during treatment and until your B cells have recovered.

If you are pregnant or planning to become pregnant, you should discuss this with your doctor, as obinutuzumab can harm an unborn baby. Women of childbearing age should use effective contraception during treatment and for 6 months after the last dose.

Commonly used with

For follicular lymphoma, obinutuzumab is most commonly used in combination with chemotherapy drugs such as bendamustine, CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone), or CVP (cyclophosphamide, vincristine, and prednisone). After the initial combination phase, it may be continued alone as maintenance therapy.

Premedications like steroids, acetaminophen, and antihistamines are routinely used before each infusion to reduce the risk of infusion-related reactions.

Commonly tested with

Obinutuzumab has been tested in combination with several chemotherapy regimens, including bendamustine, CHOP, and CVP, for the treatment of follicular lymphoma. It has also been compared to rituximab-containing regimens in clinical studies.

During treatment, your doctor will monitor your blood counts and organ function regularly, and may test for hepatitis B and other infections before starting therapy.