Managing CTCL: UK patient experience

Case study presentations with Prof. Julia Scarisbrick and Dr Wendy Osborne
This feature has been commissioned and fully funded by Takeda UK Ltd and contains promotional information.
C-APROM/UK/ADCE/0126| June 2021

ADCETRIS®(brentuximab vedotin) has received a conditional marketing authorization in Europe, and is indicated for treating adult patients with1:

CD30+ cutaneous T-cell lymphoma (CTCL) after at least 1 prior systemic therapy

  • Previously untreated CD30+ Stage IV Hodgkin lymphoma (HL) in combination with doxorubicin, vinblastine and dacarbazine (AVD)1
  • Relapsed or refractory CD30+ HL following:
    • autologous stem cell transplant (ASCT) or
    • at least two prior therapies when ASCT or multi-agent chemotherapy is not a treatment option
  • CD30+ HL at increased risk of relapse or progression following ASCT
  • Previously untreated systemic anaplastic large cell lymphoma (sALCL) in combination with cyclophosphamide, doxorubicin and prednisone (CHP)
  • Relapsed or refractory sALCL

Cutaneous T-cell lymphomas (CTCLs) are a heterogenous group of non-Hodgkin lymphomas primarily involving the skin at diagnosis.2,3 The most common subtype of CTCL is mycosis fungoides (MF), followed by primary cutaneous anaplastic large cell lymphoma (pcALCL) and the much rarer subtype, Sezary syndrome (SS).

Early-stage disease is mostly treated with skin-directed therapies; however, the chronic/relapsing nature of CTCL means that patients often require systemic therapies.4 Allogeneic stem cell transplantation is currently the only route to cure for patients with CTCL.4

In patients with CD30+ disease, brentuximab vedotin (BV) is now accepted by the SMC, and recommended by NICE and the UKCLG-BAD  guidelines as an option in the UK for adult patients with CTCL who have received at least 1 prior systemic therapy, and have mycosis fungoides stage IIB or over, primary cutaneous anaplastic large cell lymphoma or Sézary syndrome.1,5,6

During the pivotal Phase III study, BV delivered improved rates of durable response compared with physician’s choice – methotrexate or bexarotene which was consistent across subtypes* and CD30 expression (ORR4: 56.3% vs 12.5%; p<0.0001, respectively).7,8
BV demonstrated a generally manageable toxicity profile in CTCL.7 

In the first case study, Professor Scarisbrick (University of Birmingham, UK) discusses one of her patients – a 48 year old male teacher who presented with pcALCL, who relapsed with nodal spread and was bridged to transplantation following treatment with BV. This patient has remained in complete remission since 2015.

*pcALCL and MF
ORR = objective global response. ORR4 is calculated from the first response to the last response ≥4 months


Case Study 1: 48 year old male teacher with CD30+ pcALCL

“The patient had a very good experience of treatment with brentuximab…they previously had a very negative impact from the CHOP* chemotherapy” (Prof. Scarisbrick)

“As a result of brentuximab [vedotin], I returned to work quickly as a teacher of mathematics and am thoroughly enjoying life back in the classroom” (Patient)

*CHOP – cyclophosphamide, doxorubicin, vincristine, and prednisolone

In the second case study, Dr Osborne (Newcastle upon Tyne Hospitals NHS Foundation Trust, UK) discusses one of her patients – a 77 year old man who was diagnosed with MF, who had a symptomatic tongue lesion, and was treated with BV.


Case Study 2: 77 year old male with MF with a symptomatic tongue lesion

“It’s really important for patients with BV to monitor and act if they develop any neuropathy, and to follow the SPC closely” (Dr Osborne)

“If it’s managed well, then usually the neuropathy resolves” (Dr Osborne)

Click here for the GB or here for the NI prescribing information for ADCETRIS®(brentuximab vedotin) and details on reporting adverse events | Refer to the ADCETRIS UK Summaries of Product Characteristics (GB & NI) for full safety information1

ADCETRIS®(brentuximab vedotin) is subject to additional monitoring. This will allow quick identification of new safety information.


Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. Adverse events should also be reported to Takeda UK Ltd at [email protected]


ADCETRIS logo

References

1. ADCETRIS UK Summaries of Product Characteristics (GB & NI)

2. Gilson D et al. British Association of Dermatologists and U.K. Cutaneous Lymphoma Group guidelines for the management of primary cutaneous lymphomas 2018. Br J Dermatol 2019;180:496–526

3. Willemze R et al. The 2018 update of the WHO-EORTC classification for primary cutaneous lymphomas. Blood 2019;133(16):1703–1714

4. Brunner PM et al. Recent advances in understanding and managing cutaneous T-cell lymphomas. F1000Res 2020;9:F1000 Faculty Rev–331

5. National Institute of Clinical Excellence guidelines for brentuximab vedotin for treating CD30-positive cutaneous T-cell lymphoma

6. Scottish Medicines Consortium guidelines for brentuximab vedotin for treating CD30-positive cutaneous T-cell lymphoma

7. Prince HM, et al. Brentuximab vedotin or physician’s choice in CD30-positive cutaneous T-cell lymphoma (ALCANZA): an international, open-label, randomised, phase 3, multicentre trial. Lancet 2017;390(10094):555–566

8. Kim YH, et al. Outcomes by CD30 expression in patients with CTCL receiving brentuximab vedotin (BV) vs physician’s choice (PC) in the Phase 3 ALCANZA study. Abstract 7517. Presented at ASCO 2017, Chicago, IL.

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