Good post about the realities of the clinical use of bexar. The drug is expensive with little profit margin so hospitals bear the costs and deliver it in that setting. There is little profit in it for oncologists even if they administered it. Also its true that they are not trained in radiation biology and safety so nuclear medicine or radiation oncologists deliver it.
There are no good studies using the drug upfront. Rituxan and chemo is well studied. Polonged Bone marrow depression will occur upfront if bexar is used with chemo. Bone marrow effects of radiation take longer to recover than chemo. Those are some of the concerns in using it earlier in the disease.
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