Brentuximab vedotin (Adcetris)

==General information==
Class/mechanism: Anti-CD30 antibody (brentuximab) with protease-cleavable linker to chemotherapeutic agent (monomethyl auristatin E [MMAE, vedotin]). The antibody-drug complex binds to CD30 expressing cells and is internalized, where the active chemotherapeutic agent MMAE is released via proteolytic cleavage of the antibody-drug linker. MMAE is a microtubule disrupting agent that interferes with mitosis, causes cell cycle arrest, and eventual apoptosis.Brentuximab vedotin (Adcetris) package insert Brentuximab vedotin (Adcetris) package insert (locally hosted backup)Adcetris manufacturer's website
Route: IV
Extravasation: no information
For conciseness and simplicity, HemOnc.org currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias such as Micromedex, UpToDate Lexidrug, Medscape,or the prescribing information.
==Diseases for which it is established (work in progress)==
*Anaplastic large cell lymphoma
*Cutaneous T-cell lymphoma
*Classical Hodgkin lymphoma
**Pediatric Hodgkin lymphoma
*Peripheral T-cell lymphoma
==Diseases for which it is used==
*Diffuse large B-cell lymphoma
*Mediastinal gray-zone lymphoma
==Patient drug information==
*Brentuximab vedotin (Adcetris) patient drug information (Chemocare)Brentuximab vedotin (Adcetris) patient drug information (Chemocare)
*Brief patient counseling information can be found in the Brentuximab vedotin (Adcetris) package insert
*Brentuximab vedotin (Adcetris) patient drug information (UpToDate)Brentuximab vedotin (Adcetris) patient drug information (UpToDate)
==History of changes in FDA indication==
===Anaplastic large cell lymphoma===
*2011-08-19: Granted accelerated approval for treatment of patients with systemic anaplastic large cell lymphoma (sALCL) after failure of at least one prior multi-agent chemotherapy regimen. (Based on SG035-0004)
*2018-11-16: Approved in combination with chemotherapy for previously untreated systemic anaplastic large cell lymphoma (sALCL). (New treatment context; based on ECHELON-2)
===Classical Hodgkin lymphoma===
*2011-08-19: Granted accelerated approval for treatment of patients with Hodgkin lymphoma after failure of autologous stem cell transplant (ASCT) or after failure of at least two prior multi-agent chemotherapy regimens in patients who are not ASCT candidates. (Based on SG035-0003)
**2015-08-17: Converted to full approval for the post-autologous hematopoietic stem cell transplantation (auto-HSCT) consolidation treatment of patients with classical Hodgkin lymphoma (HL) at high risk of relapse or progression. (new treatment context added; based on AETHERA)
*2018-03-20: Approved to treat adult patients with previously untreated stage III or IV classical Hodgkin lymphoma (cHL) in combination with chemotherapy. (New treatment context; based on ECHELON-1)
===Diffuse large B-cell lymphoma; High-grade B-cell lymphoma; Transformed lymphoma===
*2025-02-11: Approved in combination with lenalidomide and a rituximab product for adult patients with relapsed or refractory large B-cell lymphoma (LBCL), including diffuse large B-cell lymphoma (DLBCL) not otherwise specified (NOS), DLBCL arising from indolent lymphoma, or high-grade B-cell lymphoma (HGBL), after two or more lines of systemic therapy who are ineligible for autologous hematopoietic stem cell transplantation (auto-HSCT) or CAR T-cell therapy. (Based on ECHELON-3)
===Pediatric Hodgkin lymphoma===
*2022-11-10: Approved in combination with doxorubicin, vincristine, etoposide, prednisone, and cyclophosphamide for pediatric patients 2 years of age and older with previously untreated high risk classical Hodgkin lymphoma (cHL). (Based on COG AHOD1331)
===Cutaneous T-cell lymphoma===
*2017-11-09: Regular approval for the treatment of adult patients with primary cutaneous anaplastic large cell lymphoma (pcALCL). (New disease indication; based on ALCANZA)
*2017-11-09: Regular approval for the treatment of adult patients with CD30-expressing mycosis fungoides (MF) who have received prior systemic therapy. (Based on ALCANZA)
===Peripheral T-cell lymphoma===
*2018-11-16: Approved in combination with chemotherapy for previously untreated CD30-expressing peripheral T-cell lymphomas (PTCL), including angioimmunoblastic T-cell lymphoma and PTCL not otherwise specified. (New disease indication; based on ECHELON-2)
==History of changes in EMA indication==
===Anaplastic large cell lymphoma===
*2012-10-25: Initial authorization as Adcetris. Adcetris is indicated for the treatment of adult patients with relapsed or refractory systemic anaplastic large cell lymphoma (sALCL). (Based on SG035-0004)
*2020-05-12: Extension of indication to include in combination with cyclophosphamide, doxorubicin, and prednisone treatment of adults with previously untreated CD30+ sALCL.
===Classical Hodgkin lymphoma===
*2012-10-25: Initial authorization as Adcetris. Adcetris is indicated for the treatment of adult patients with relapsed or refractory CD30+ Hodgkin lymphoma (HL) following autologous stem cell transplant (ASCT). (Based on SG035-0003)
*2012-10-25: Initial authorization as Adcetris. Adcetris is indicated for the treatment of adult patients with relapsed or refractory CD30+ Hodgkin lymphoma (HL) following at least two prior therapies when ASCT or multi-agent chemotherapy is not a treatment option. (Based on SG035-0003)
*2016-06-24: Extension of Indication to include the treatment of adult patients with Hodgkin Lymphoma (HL) at increased risk of relapse or progression following autologous stem cell transplantation (ASCT).
*2019-02-06: Extension of the existing Hodgkin lymphoma (HL) indication to include the frontline treatment of adult patients with CD30+ Stage IV Hodgkin lymphoma (HL) in combination with doxorubicin, vinblastine and dacarbazine (AVD). (Based on ECHELON-1)
*Future date (CHMP positive summary): Extension of the existing Hodgkin lymphoma (HL) indication to include the frontline treatment of adult patients with CD30+ Stage III or IV Hodgkin lymphoma (HL) in combination with doxorubicin, vinblastine and dacarbazine (AVD).
===Cutaneous T-cell lymphoma===
*2017-12-15: Extension of indication for the treatment of adult patients with CD30+ cutaneous T-cell lymphoma (CTCL) who require systemic therapy. (Based on ALCANZA)
==History of changes in Health Canada indication==
*2013-02-01: Initial notice of compliance with conditions
*2020-05-12: Conditions were met
==History of changes in PMDA indication==
*2014-01-17: Initial approval for the treatment of relapsed or refractory CD30-positive Hodgkin's lymphoma and anaplastic large cell lymphoma.
*2018-09-21: New indication and a new dosage for the treatment of CD30-positive Hodgkin's lymphoma.
*2019-12-20: New indication and a new dosage for the treatment of CD30-positive peripheral T-cell lymphoma.
*2023-11-24: New indication and a new dosage for the treatment of relapsed or refractory CD30-positive cutaneous T-cell lymphoma.
==Also known as==
*Code names: SGN-35, cAC10-vcMMAE
*Brand name: Adcetris 
==References==
Category:Drugs
Category:Intravenous medications
Category:Protein expression-specific medications
Category:Anti-CD30 antibody-drug conjugates
Category:Microtubule inhibitors
Category:Anaplastic large cell lymphoma medications
Category:Classical Hodgkin lymphoma medications
Category:Cutaneous T-cell lymphoma medications
Category:Diffuse large B-cell lymphoma medications
Category:High-grade B-cell lymphoma medications
Category:Mediastinal gray-zone lymphoma medications
Category:Peripheral T-cell lymphoma medications
Category:Transformed lymphoma medications
Category:FDA approved in 2011
Category:EMA approved in 2012
Category:Health Canada approved in 2013
Category:PMDA approved in 2014