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Treatment Name: Brentuximab Vedotin (Adcetris®)

Brentuximab Vedotin (Adcetris®) is a Chemotherapy Regimen for Hodgkin's Lymphoma

How does Brentuximab Vedotin work?
Brentuximab vedotin is an antibody that targets Hodgkin lymphoma cells. Once it binds to the lymphoma cell surface, it then enters the inside of the cancer cell. Once inside the cell, the antibody releases a drug called MMAE, which stops the cell from growing and dividing.

Goals of therapy:
Brentuximab vedotin is given to shrink lymph nodes, alleviate symptoms of Hodgkin Lymphoma, and achieve disease remission. If remission is achieved, some patients may receive a bone marrow transplant with the goal of cure.

Schedule

  • Brentuximab vedotin is an intravenous (I.V.) infusion usually given over 30 minutes on Day 1 of each cycle
  • Patients weighing more than 220 lbs. (100 kg) should have their dose of brentuximab calculated based upon a maximum weight of 220 lbs

Brentuximab vedotin is usually given in an outpatient infusion center, allowing the person to go home afterwards. On occasion, brentuximab vedotin may be given in the hospital if someone is too sick.

Brentuximab vedotin is repeated every 21 days. This is known as one Cycle. Each cycle is repeated until disease remission is achieved unless the drug does not work or intolerable side effects occur.

Click here for common starting dose

Maintenance:
Patients who have received an autologous stem cell transplant who are at high risk of relapse may benefit from maintenance therapy with brentuximab vedotin:

  • Maintenance therapy dose beginning 30 - 45 days after stem cell transplant: Brentuximab vedotin I.V. infused over 30 minutes, repeated every 3 weeks for up to 16 cycles

Click here for common maintenance dose

Side Effects

In clinical studies, the most commonly reported side effects with brentuximab vedotin are shown here:

  • Numbness and tingling in fingers and toes (42%)
  • Nausea (35%)
  • Fatigue (34%)
  • Low white blood cells (19%)
  • Diarrhea (18%)
  • Fever (14%)
  • Vomiting (13%)
  • Joint pain (12%)
  • Itching (12%)
  • Muscle pain (11%)
  • Damage to nerves leading to muscle weakness (11%)
  • Hair loss (10%)

Approximately 20% of patients discontinue brentuximab vedotin due to unacceptable side effects.

Side effect videos Side Effect Videos
Nausea and VomitingNausea and VomitingFatigue Fatigue DiarrheaDiarrheaHair LossHair LossNeutropenic FeverNeutropenic FeverPainPain

Monitoring

How often monitoring needed?
Labs (blood tests) may be checked before treatment, prior to each cycle, and also periodically during treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), uric acid, lactate dehydrogenase (LDH), plus any others your doctor may order.

How often is imaging needed?
Imaging may be checked before treatment, then before Cycles 2, 4, 7, 10, 13, 16, then every 12 weeks. Imaging may include: computerized tomography (CT) scans or positron emission tomography (PET) scans.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue chemotherapy as planned, or delay or switch therapy.

ChemoExperts Tips

  • Infusion reactions 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
  • Patients weighing more than 220 lbs. should have their dose of brentuximab calculated based upon a maximum weight of 220 lbs
  • Brentuximab should not be given with bleomycin due to the risk of lung toxicity
  • 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
  • Tell your doctor if you are pregnant or trying to become pregnant as brentuximab treatment may cause fetal harm. It is advised that nursing mothers either discontinue nursing or discontinue brentuximab treatment
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for Hodgkin 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 Brentuximab Vedotin (Adcetris®), 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 Brentuximab Vedotin (Adcetris®). 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 Brentuximab Vedotin (Adcetris®) 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.

Emotional Wellness

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 Brentuximab Vedotin (Adcetris®)

Individual Drug Label Information

Bren­tuxi­mab Vedotin (Adcetris®)

  • Brentuximab vedotin is an intravenous (I.V.) infusion 
  • FDA Black Box Warning: A rare viral infection known as JC virus, has been diagnosed in some patients who received treatment with Brentuximab.  Patients themselves or family and friends should immediately report the following symptoms to the doctor: confusion, trouble speaking, loss of memory, changes in vision, difficulty walking, or weakness on one side of the body
  • Dosage adjustments may be required for liver dysfunction, low white blood cell counts, or nerve pain 
  • May interact with certain antifungal and seizure medications. Ask your doctor or pharmacist to review your medications for any possible interactions  
  • May interact with grapefruit and grapefruit juice causing increased blood levels of MMAE, the drug attached to brentuximab vedotin. This could increase your risk of experiencing side effects. Avoid eating grapefruit and drinking anything containing grapefruit juice during treatment 
  • Avoid therapy with St. Johns Wort as it will decrease blood levels of MMAE. This could decrease the effectiveness of brentuximab vedotin 
General Brentuximab Vedotin Side Effects 
  • Nerve pain such as numbness, tingling, burning, or weakness in hands or feet, also known as peripheral sensory neuropathy, may increase after each dose. It is usually reversible if treatment is stopped or the dose is decreased
  • Neutropenia, or low white blood cell counts, may occur which increases your risk of an infection.  Tell your doctor if you have a fever of 100.5° F or higher or any other concern for infection such as cough, chills, sore throat, or painful urination
  • Rash is common after treatment.  A severe rash such as Stevens-Johnson Syndrome may occur and requires immediate medical attention 
  • Click on the brentuximab vedotin (Adcetris) package insert for reported side effects and possible drug interactions

Side Effect Videos
DiarrheaDiarrheaHair LossHair LossFatigue Fatigue

See DailyMed package insert.

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References

1. Younes A, Gopal AK, Smith SE, et al. Results of a pivotal phase II study of brentuximab vedotin for patients with relapsed or refractory Hodgkin's lymphoma. J Clin Oncol. 2012;30:2183-2189.

2. Moskowitz CH, Nademanee A, Masszi T, et al. Brentuximab vedotin as consolidation therapy after autologous stem-cell transplantion in patients with Hodgkin's lymphoma at risk of relapse or progression (AETHERA): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2015;385:1853-1862.

Created: August 24, 2015 Updated: September 5, 2018

What is Hodgkin's Lymphoma?

Hodgkin Lymphoma is a disease of the white blood cells known as B-lymphocytes which are normally found in lymph nodes, blood, and throughout the body. Hodgkin lymphoma most commonly affects lymph nodes found in the neck or center of the chest. There are different types of Hodgkin lymphoma, many of which are rare. Most Hodgkin lymphomas are diagnosed by the presence of a specific cell known as the Reed-Sternberg cell. Known causes of lymphoma may include family history of Hodgkin lymphoma, history of infection with the Epstein-Barr virus, use of immunosuppressive medications, or HIV infection, while some causes are still unknown. The stage of Hodgkin lymphoma can vary at diagnosis and throughout treatment. Stages of Hodgkin’s lymphoma include I, II, III, IV. The effectiveness of the treatment may depend upon the stage at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

Clinical Studies

If you are interested in reading the clinical trials results, please click on references below:

1. Younes A, Gopal AK, Smith SE, et al. Results of a pivotal phase II study of brentuximab vedotin for patients with relapsed or refractory Hodgkin's lymphoma. J Clin Oncol. 2012;30:2183-2189.

2. Moskowitz CH, Nademanee A, Masszi T, et al. Brentuximab vedotin as consolidation therapy after autologous stem-cell transplantion in patients with Hodgkin's lymphoma at risk of relapse or progression (AETHERA): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2015;385:1853-1862.

Common Starting Dose

  • Brentuximab vedotin 1.8 mg/kg (maximum dose of 180 mg) intravenous infusion over 30 minutes on Day 1 of each cycle
  • Patients weighing more than 220 lbs. should have their dose of brentuximab calculated based upon a maximum weight of 220 lbs

Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability

Common Maintenance Dose

  • Maintenance therapy usually begins 30 - 45 days after stem cell transplant: Brentuximab vedotin 1.8 mg/kg (maximum dose of 180 mg) intravenous infusion over 30 minutes, repeated every 3 weeks for up to 16 cycles

Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium

What does Cure mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.