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Treatment Name: BV-CHP (Brentuximab Vedotin (Adcetris®) + Cyclophosphamide + Doxorubicin + Prednisone)

BV-CHP (Brentuximab Vedotin (Adcetris®) + Cyclophosphamide + Doxorubicin + Prednisone) is a Chemotherapy Regimen for Lymphoma, T-Cell

How does BV-CHP work?

Brentuximab vedotin is an antibody that specifically targets T-cell lymphoma cells. Once it binds to the lymphoma cell surface, it then enters the inside of this cancer cell. Once inside the cell, the antibody releases a drug called MMAE, which stops the cancer cell from growing and dividing.

Each of the medications in CHP, as shown below, also help to kill cancerous T-lymphocytes.

BVBrentuximab Vedotin (Adcetris®)
C – Cyclophosphamide (Cytoxan®)
H – Hydroxydaunorubicin (Doxorubicin)
P – Prednisone

Alternative names: A + CHP, brentuximab vedotin + CHP, brentuximab + CHP

Goals of BV-CHP therapy:

BV-CHP is given to shrink T-cell lymphoma and reduce symptoms caused by the lymphoma. BV-CHP is commonly given with the goal of cure.

Schedule

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How is BV-CHP therapy for T-cell lymphoma given?

  • Brentuximab vedotin intravenous (I.V.) infusion over 30 minutes on Day 1
  • Cyclophosphamide (Cytoxan) I.V. infusion over 30 to 60 minutes on Day 1
  • Hydroxydaunorubicin (doxorubicin) I.V. push or I.V. infusion over 15 minutes on Day 1
  • Prednisone 100 mg (two 50 mg oral tablets) by mouth on Days 1, 2, 3, 4, and 5

Estimated total infusion time for this treatment:

  • Up to 2 hours for Day 1 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

BV-CHP is usually given in an outpatient infusion center, allowing the person to go home afterwards. On occasion, it may be given in the hospital if someone is too sick.

BV-CHP is repeated every 21 days. This is known as one Cycle. Each cycle may be repeated up to 8 times. Duration of therapy may last up to 6 months, depending upon response, tolerability, and number of cycles prescribed.

Click here for the common BV-CHP starting doses for T-cell lymphoma.

Side Effects

What are the most common side effects from BV-CHP for T-Cell lymphoma?

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 BV-CHP are shown here:

On average, 6% of patients discontinue BV-CHP treatment due to unacceptable side effects.

Importantly, not all people who experience a side effect from BV-CHP 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 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 BV-CHP, 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.

Watch videos on common BV-CHP therapy side effects below

Side effect videos Side Effect Videos
Nausea and VomitingNausea and VomitingPainPainDiarrheaDiarrheaConstipationConstipationHair LossHair LossNeutropenic FeverNeutropenic FeverFatigue Fatigue AnemiaAnemia

Monitoring

How often is monitoring needed with BV-CHP treatment?

Labs (blood tests) may be checked before each treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), Lactate Dehydrogenase (LDH), blood phosphorous levels, uric acid levels, plus any others your doctor may order.

How often is imaging needed with BV-CHP treatment?

Imaging may be checked before treatment and after 3 to 4 cycles to determine how well the chemotherapy is working or at the discretion of your doctor if there are concerns for certain side effects. Imaging may include: X-rays, magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans.

How might blood test results/imaging affect with BV-CHP treatment?

Depending upon the results, your doctor may advise to continue BV-CHP as planned, reduce the dose of future treatments, delay the next treatment until the side effect goes away, or switch to an alternative therapy.

ChemoExperts Tips

  • Filgrastim or pegfilgrastim 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
  • 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 (Adcetris)
  • 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
  • Don't forget take your oral prednisone on Days 1 - 5 of each cycle! This is part of the anti-cancer therapy and also helps prevent nausea and vomiting with this regimen. Your doctor will give you a prescription to fill at your outpatient pharmacy
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for T-cell 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 BV-CHP (Brentuximab Vedotin (Adcetris®) + Cyclophosphamide + Doxorubicin + Prednisone), 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 BV-CHP (Brentuximab Vedotin (Adcetris®) + Cyclophosphamide + Doxorubicin + Prednisone). Depending upon your income, they may be able to help cover the cost of:

  • Bren­tuxi­mab Vedotin
  • Cyclo­phospha­mide IV
  • Doxorubicin
  • Pred­nisone

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 BV-CHP (Brentuximab Vedotin (Adcetris®) + Cyclophosphamide + Doxorubicin + Prednisone) 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 BV-CHP (Brentuximab Vedotin (Adcetris®) + Cyclophosphamide + Doxorubicin + Prednisone)

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.

Cyclo­phospha­mide IV (Cytoxan®)

  • Cyclophosphamide is administered as an intravenous (I.V.) infusion
  • May decrease the ability to become pregnant. Fertility preservation is recommended in couples wishing to become pregnant.
  • A smaller dosage may be required for patients receiving hemodialysis
  • Has been linked to the development of other cancers in a small number of people
General Cyclophosphamide (Cytoxan) Side Effects
  • Low white blood cell count which can increase the risk of infection
  • Nausea or vomiting, which can be acute (first 24 hours) or delayed (Days 2 – 5)
  • Hair loss, which is usually reversible
  • Click on the cyclophosphamide (Cytoxan) package insert below for reported side effects and potential drug Interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingHair LossHair LossNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

Doxorubicin (Adriamycin®)

  • Doxorubicin is administered as an intravenous infusion and is red in color
  • Can affect heart function. A heart study (echocardiogram) may be required before receiving the first dose
  • Dosage may be reduced in patients with poor liver function
  • Has been linked to the development of other cancers in a small number of people (1.5% chance at 10 years)
General Doxorubicin (Adriamycin) Side Effects
  • Nausea, vomiting, diarrhea, and mouth sores (stomatitis)
  • Leakage into skin or surrounding muscle during infusion may cause severe irritation (extravasation)
  • May temporarily turn urine orange
  • Hair loss, which is usually reversible
  • Increased risk of infection due to decrease white blood cell count (neutropenia)
  • Click on the doxorubicin (Adriamycin) package insert for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossPainPainNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

Pred­nisone (Deltasone®)

  • Prednisone is an oral medication, usually supplied as a white tablet
  • Prednisone may increase the risk of infection. Depending upon how much prednisone is taken, antibiotics may be prescribed to help prevent infections during treatment with prednisone
  • Should be taken with food and with a large glass of water to avoid stomach irritation or ulcers
  • Should be taken before 6 P.M. when possible, to avoid trouble falling asleep
  • May decrease the response to vaccines; vaccines may need to be repeated at a later date to obtain maximal response
  • If taken daily for several days or weeks, the dose of prednisone may need to be gradually decreased to avoid withdrawal symptoms
  • If you miss a dose, take the next dose as soon as possible
  • Should be stored at room temperature
General Prednisone Side Effects
  • May cause high blood sugar, weight gain, irritability, high blood pressure, difficulty sleeping, stomach ulcers, bone loss, muscle weakness
  • Click on the Prednisone package insert below for reported side effects and potential drug Interactions
See DailyMed package insert.

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References

1.) Horwitz S, O'Connor OA, Pro B, et al. Brentuximab vedotin with chemotherapy for CD30-positive peripheral T-cell lymphoma (ECHELON-2): a global, double-blind, randomised, phase 3 trial. Lancet 2019;393:229-240.

Created: April 13, 2020 Updated: April 17, 2020

What is Lymphoma, T-Cell?

A disease of lymphocytes called T-lymphocytes, or "T-cells" that are found most commonly in the skin, spleen, blood, bone marrow, and/or lymph nodes. Peripheral T-cell lymphoma (PTCL) and cutaneous T-cell lymphoma (CTCL) are the two main types of T-cell lymphoma; however, there are many different subtypes of PTCL and CTCL and all are very rare.

The exact cause of T-cell lymphomas is not known, but certain viral infections such as the Epstein-Barr Virus (EBV) and human T-cell leukemia virus have been associated with development of T-cell lymphomas. The stage of T-cell lymphoma can vary at diagnosis and throughout treatment. Stages of T-cell lymphoma include stage I, II, III, and IV. The effectiveness of the treatment may depend upon the stage and specific subtype 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.

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.

Common BV-CHP Starting Doses

  • Brentuximab vedotin 1.8 mg/kg (maximum 180 mg) intravenous (I.V.) infusion over 30 minutes on Day 1
  • Cyclophosphamide 750 mg/m2 I.V. infusion over 30 to 60 minutes on Day 1
  • Hydroxydaunorubicin (doxorubicin) 50 mg/m2 I.V. push or I.V. infusion over 15 minutes on Day 1
  • Prednisone 100 mg (two 50 mg oral tablets) by mouth on Days 1, 2, 3, 4, and 5

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