Treatment Name: AAVD (Brentuximab vedotin, Doxorubicin, Vinblastine, Dacarbazine)
AAVD (Brentuximab vedotin, Doxorubicin, Vinblastine, Dacarbazine) is a Chemotherapy Regimen to treat Hodgkin's Lymphoma
How does AAVD chemo work?
- Brentuximab vedotin (Adcetris®) is an antibody that targets Hodgkin lymphoma cells. After it binds to the lymphoma cell surface, it then enters the cancer cell. Once inside the cell, the antibody releases a drug called MMAE, which stops the lymphoma from growing and dividing
- Doxorubicin, vinblastine, and dacabazine are designed to kill or slow the growth of Hodgkin lymphoma cells
A – Adcetris® (Brentuximab Vedotin)
A – Adriamycin® (Doxorubicin)
V - Vinblastine
D – Dacarbazine
Alternate regimen name: A+AVD
Goals of AAVD therapy:
AAVD treatment is given to shrink enlarged lymph nodes, and decrease symptoms from Hodgkin lymphoma such as fever, night sweats, and weight loss. By completely eliminating all Hodgkin lymphoma cells, AAVD chemotherapy is commonly given with the goal of cure.
- Brentuximab vedotin intravenous (I.V) infusion over 30 minutes on Days 1 and 15
- Doxorubicin I.V push or infusion over 15 minutes on Days 1 and 15
- Vinblastine I.V. infusion over 5 to 10 minutes on Days 1 and 15
- Dacarbazine I.V. infusion over 30 minutes on Days 1 and 15
Typically all four drugs are given on Days 1 and 15 of each cycle, unless the doctor discontinues one or more for side effects or toxicity.
Estimated total infusion time for AAVD chemotherapy:
- Up to 3 hours for Days 1 and 15 of each cycle
- Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time
The AAVD chemotherapy regimen is usually given in an outpatient infusion center, allowing the person to go home afterwards. On occasion, AAVD may be given in the hospital if someone is too sick for outpatient treatment.
AAVD chemo is repeated every 28 days. This is known as one Cycle. Each cycle may be repeated up to six times, depending upon the stage of the disease and response to previous cycles. Duration of therapy may last up to six months, depending upon response, tolerability, and number of cycles prescribed.
Click here for the common AAVD treatment starting doses.
Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability.
In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported side effects of AAVD are shown here:
A note about side effect percentages
- Tingling or numbness or pins and needles sensation in fingers or toes, (up to 67%)*
- Low white blood cells [neutropenia], (58%)
- Infection, (55%)
- Nausea, (53%)
- Constipation, (42%)
- Vomiting, (33%)
- Fatigue, (32%)
- Diarrhea, (27%)
- Fever, (27%)
- Hair loss, (26%)
- Weight loss, (22%)
- Low red blood cells [anemia], (21%)
- Stomach pain, (21%)
- Sores on mouth and tongue, (21%)
- Neutropenic fever, (19%)**
- Bone pain, (19%)
- Trouble sleeping [insomnia], (19%)
- Decreased appetite, (18%)
- Cough, (15%)
- Headache, (14%)
- Joint pain, (13%)
- Heartburn, (13%)
- Back pain, (13%)
- Shortness of breath, (12%)
- Muscle pain, (12%)
- Pain in arms or legs, (12%)
- Sore throat, (11%)
- Sinus infection, (11%)
On average, less than 1% of patients discontinue treatment due to unacceptable side effects.
*Note: By the last follow-up visit, two out of three patients have either improvement or complete disappearance of tingling or numbness or pins and needles sensation in fingers or toes.
**Note: Neutropenic fever, also called febrile neutropenia, was more common in adults older than 60 years of age.
Importantly, not all people who experience a side effect from AAVD treatment will experience it in the same way. It may be mild in some or severe in others, depending upon the individual. Everybody is different. Additionally, side effects may vary over time. For some, side effects may be a reason to delay or switch treatment, reduce the dose, or avoid future treatment with a certain medication altogether.
Side effects may be treatable when they occur or preventable by taking certain medications before they happen. When medications are taken to prevent a problem, this is known as prophylaxis, or "prophy" for short.
After starting treatment with AAVD, be sure to come back and watch all of the side effect videos shown below. Each of these videos contain valuable information about side effect management that will hopefully help you to both feel better and stay out of the hospital.
How often is monitoring needed?
Labs (blood tests) may be checked before each treatment but may be checked more often if needed. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others your doctor may order.
How often is imaging needed?
Imaging may be checked before treatment, at the end of cycle 2 (end of second 28-day cycle), then at the completion of treatment. Imaging may include: X-rays, magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans. Per your doctor’s recommendation, imaging may also be checked after therapy during the follow-up period, for example, as often as every 3 months during the first year and every 6 months thereafter.
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue AAVD as planned, reduce the dose of future treatments, delay the next dose until the side effect goes away, or switch to an alternative therapy.
- Filgrastim (Neupogen®) or pegfilgrastim (Neulasta®) is recommended after each chemotherapy cycle to stimulate production of white blood cells, avoid periods of low white blood cell count (neutropenia), and prevent neutropenic fever
- In the AAVD clinical trial, fewer patients developed neutropenic fever if they were given filgrastim (Neupogen®) or pegfilgrastim (Neulasta®) after each cycle compared to those who did not receive these medications (11% compared to 21%, respectively)
- Tell your doctor if you have numbness, tingling, burning, or weakness in hands or feet as this may require a decrease in brentuximab dose or delaying future doses
- Infusion reactions with brentuximab are rare, but can occur. The most common infusion related reactions are chills, nausea, trouble breathing, itching, fever, and cough. If infusion reactions are experienced, premedications can be given before future doses of brentuximab vedotin
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for Hodgkin’s Lymphoma. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for AAVD (Brentuximab vedotin, Doxorubicin, Vinblastine, Dacarbazine), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for AAVD (Brentuximab vedotin, Doxorubicin, Vinblastine, Dacarbazine). Depending upon your income, they may be able to help cover the cost of:
- Brentuximab Vedotin
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as AAVD (Brentuximab vedotin, Doxorubicin, Vinblastine, Dacarbazine) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.
What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.
Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.
Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.
Learn more about pursuing emotional wellness while receiving treatment with AAVD (Brentuximab vedotin, Doxorubicin, Vinblastine, Dacarbazine)