Brentuximab vedotine

Brentuximab vedotin is an antibody-drug conjugate (ADC) with a monoclonal antibody directed against human CD30 antigen. The antibody is covalently bound to 3-5 molecules of the cytostatic agent monomethylauristatin E (spindle toxin). Brentuximab vedotin has been approved in the European Union for the treatment of Hodgkin's lymphoma and anaplastic large cell lymphoma since October 2012. Since the end of 2017, the indication has been extended to include CD30 positive cutaneous T-cell lymphoma. Brentuximab vedotin hasorphan drug status for the treatment of rare diseases.

The ability of monoclonal antibodies to specifically recognize certain cell characteristics can also be used in oncological therapy: antibodies are designed to detect tumour cells and transport the cytostatic drug specifically to the tumour target cell. The antibody-drug conjugate is fixed to the surface of the CD30 positive tumor cell. The antibody-drug conjugate is then introduced into the cell. There the conjugate is enzymatically cleaved; the cytostatic drug(monomethylauristatin E) can unfold its effectiveness by destroying the mitotic spindle. This leads to G2/M cell cycle arrest and apoptosis of the cell.

Brentuximab Vedotine was tested in two pivotal Phase II studies in 160 patients in the USA, Canada and Europe, 102 of whom had Hodgkin's lymphoma and 58 of whom had sALCL. In the Hodgkin's lymphoma study, all 102 patients had already received high-dose chemotherapy with autologous stem cell transplantation (ASCT) and were pretreated with multiple chemotherapy regimens. Brentuximab Vedotine was given for a maximum of 16 cycles. 96 % of patients achieved disease control (i.e. remission or disease stabilization), 94 % of patients showed tumor reduction and 75 % of patients had an objective overall response (ORR = partial or complete remission) (Younes A et al. 2012)

In the sALCL study, 58 patients who had failed at least one previous combination chemotherapy received Brentuximab Vedotin for a maximum of 16 cycles. Here, 97% of the patients achieved tumour reduction and 86% of the patients achieved an objective overall response (ORR = partial or complete remission).

In the pivotal randomized, multicenter ALCANZA study, which was conducted in 13 European countries in patients with cutaneous T-cell lymphoma (Prince HM et al. 2017), 131 participants with pretreated mycosis fungoides and primary anaplastic large cell lymphoma were treated with Brentuximab Vedotine or with oral methotrexate or Bexarotene. At least 10% of the tumor cells had to express CD30. After a median follow-up of 22.9 months, progression-free survival was 16.7 months in the Brentuximab vedotine arm versus 3m5 months in the control arm (Prince HM et al. 2017).

The treatment-related side effects with brentuximab vedotin in all studies were mainly grade 1 (minor side effects) or 2 (general condition worsened, chemotherapeutic agent must be reduced). Grade 3 (interruption of chemotherapy necessary) or 4 (hospitalization required) adverse reactions were caused by cytopenias (especially neutropenia). The most frequent side effects of WHO severity grades 3 or 4 in the pivotal study on Hodgkin's lymphoma (102 patients) were Neutropenia 20 %, peripheral neuropathy 9 %, thrombocytopenia 8 %, anemia 6 % (Younes A et al. 2012).

Neuropathies generally regressed over time (Pro B et al 2012). However, in the pivotal study for cutaneous T-cell lymphomas (CTCL), 24% of patients had to discontinue treatment due to peripheral neuropathies (Siegmund-Schultze N 2018). Cases of progressive multifocal leukoencephalopathy (PML) have also been described.

Adcetris®

1. Assaf C et al. (2021) Care structure of patients with mycosis fungoides and Sezary syndrome in Germany - health services research based on SHI routine data. JDDG 20: 643-652
2. Prince HM et al. (2017) Brentuximab vedotin or physician's choice in CD30-positive cutaneous T-cell lymphoma (ALCANZA): an international, open-label, randomized, phase 3,multicentre trial. Lancet 390:555-566.
3. Pro B et al (2012) Brentuximab Vedotin (SGN-35) in Patients With Relapsed or Refractory Systemic Anaplastic Large-Cell Lymphoma: Results of a Phase II Study. J Clin Oncol 30: 2190-2196
4. Senter PD et al. (2012) The discovery and development of brentuximab vedotin for use in relapsed Hodgkin lymphoma and systemic anaplastic large cell lymphoma. Nat Biotechnol 30: 631-637
5. Siegmund-Schultze N (2018) Cutaneous T-cell lymphomas. Dtsch Ärztebl 115: 765
6. Younes A et al. (2012) Results of a Pivotal Phase II Study of Brentuximab Vedotin for Patients With Relapsed or Refractory Hodgkin's Lymphoma. J Clin Oncol 30: 2183-2189