Brentuximab vedotin (SGN-35) for Hodgkins Lymphoma and Systemic Anaplastic large cell Lymphoma

SUMMARY: Brentuximab vedotin (SGN-35) is an antibody-drug conjugate (ADC) that targets CD30, which is a protein  expressed on cancer cells in patients with Hodgkin’s lymphoma (HL) as well as Anaplastic Large Cell Lymphoma (ALCL), an aggressive type of T-cell non-Hodgkin’s lymphoma. This ADC consists of an anti-CD30 monoclonal antibody linked to monomethyl auristatin E (MMAE), an antimicrotubule agent. Upon binding to the CD30 molecule on the cancer cells, MMAE is released into the cancer cell resulting in cell death. Taking advantage of this dual action, targeted mechanism of action of brentuximab vedotin , two phase II studies were conducted, one in patients with relapsed or refractory HL and the other in patients with relapsed or refractory systemic ALCL. In the HL pivotal trial, 102 relapsed or refractory Hodgkin lymphoma patients who had failed prior autologous stem cell transplant (ASCT) had an overall objective response rate of 75% and 34% of the patients went into complete remission (CR). The median duration of response for all responding patients was 6.7 months, and the median duration of response for patients achieving a CR was 20.5 months. The estimated 12-month overall survival for all patients was 89 percent. J Clin Oncol 29: 2011 (suppl; abstr 8031). In the second phase II trial, of the 58 patients with relapsed or refractory systemic ALCL, 86% achieved an objective response and 57% went into CR. The median duration of overall objective response was 12.6 months and the median duration of response for patients achieving a CR was 13.2 months. Median overall survival had not been reached. J Clin Oncol 29: 2011 (suppl; abstr 8032). Brentuximab was very well tolerated with the most common adverse event being peripheral sensory neuropathy. Based on these data, the Oncologic Drugs Advisory Committee (ODAC) voted 10-0 to recommend that the FDA grant accelerated approval of brentuximab vedotin. The results from the above two studies will change the treatment paradigm in this difficult to treat patient population.