What is the role of brentuximab vedotin as first line salvage therapy prior to ASCT?

FAQ published on November 13, 2017
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John Sweetenham, MD, FRCP, FACP
Professor of Medicine
Executive Medical Director
Senior Director for Clinical Affairs
Huntsman Cancer Institute
University of Utah
Salt Lake City, Utah
What is the role of brentuximab vedotin as first line salvage therapy prior to ASCT?

Welcome to Managing Hodgkin Lymphoma. I am Dr. John Sweetenham. I am frequently asked, “What is the role of brentuximab vedotin as first-line salvage therapy prior to autologous stem cell transplantation?” This is a really important question for a number of reasons, not least because we know that brentuximab vedotin now has a role in posttransplant consolidation. The question is, could it still be used prior to the transplant, and would consolidation therapy with the same agent then still have a role? At the moment, there are a number of single-agent studies which have demonstrated a role for brentuximab vedotin immediately prior to stem cell transplant. One study in particular, performed in California, demonstrates that 37 patients with relapsed and refractory Hodgkin lymphoma received single-agent brentuximab vedotin, a response rate of 86% was demonstrated. The majority of these patients, in fact it was 32, were able to proceed to high-dose therapy and stem cell transplant with a normal peri-transplant course. The ability to collect stem cells was not affected, and these patients tolerated their treatment normally. This gives a clue that single-agent activity of brentuximab vedotin prior to a transplant is high. At the moment, there are ongoing studies adding brentuximab vedotin to other conventional regimens, such as the ICE regimen which is a commonly used chemotherapy salvage regimen. Those studies are ongoing, but the hope is that by combining antibody-drug conjugates plus conventional chemotherapy, that we will see a higher rate of complete response and PET negativity, which will hopefully then convert into a higher survival rate following autologous stem cell transplantation. As I already mentioned, based on the data that we already have on re-treatment with brentuximab vedotin, the use of this agent as consolidation therapy in those patients who have BV prior to their transplant does seem to be a rational treatment approach. Also, it appears to be a tolerable approach for these patients. Thank you for viewing this activity.

Last modified: October 24, 2017
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