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The 2022 Tandem Meetings | Current indications for the use of brentuximab vedotin in Hodgkin lymphoma

Anna Sureda, MD, PhD, Catalan Institute of Oncology, Duran I Reynals Hospital, Barcelona, Spain, outlines the indications for brentuximab vedotin in Hodgkin lymphoma (HL) and comments on the management of brentuximab vedotin-induced peripheral sensory neuropathy. Brentuximab vedotin is currently used in a wide range of settings in HL, including frontline and consolidation therapy. Peripheral sensory neuropathy is a common side effect induced by brentuximab vedotin. Guidelines for the management of this adverse event recommend decreasing the drug dose or increasing the time interval between each dose. Patients who still experience neurotoxicity after this should stop using the drug definitively. This interview took place at the Transplantation & Cellular Therapy (TCT) Meetings of ASTCT™ and CIBMTR® 2022 in Salt Lake City, Utah.

Transcript (edited for clarity)

So BV is being more and more used in patients with classical Hodgkin Lymphoma. It was demonstrated to be very effective in the relapsed/refractory setting as monotherapy, but nowadays we can also use it as consolidation strategy in patients that have a high relapse risk after an autologous stem cell transplant. It’s being used for patients that are not eligible for autologous stem cell transplantation or for those patients that are candidates for auto-transplant, but they have not achieved metabolic complete remission with the standard of care salvage chemotherapy...

So BV is being more and more used in patients with classical Hodgkin Lymphoma. It was demonstrated to be very effective in the relapsed/refractory setting as monotherapy, but nowadays we can also use it as consolidation strategy in patients that have a high relapse risk after an autologous stem cell transplant. It’s being used for patients that are not eligible for autologous stem cell transplantation or for those patients that are candidates for auto-transplant, but they have not achieved metabolic complete remission with the standard of care salvage chemotherapy. And even BV has moved to the frontline therapy with the data that we have from the ECHELON-1 trial in patients with advanced stage classical Hodgkin lymphoma. So the major toxicity of brentuximab vedotin doing is peripheral sensory neuropathy, which was a toxicity that we have learned how to manage since BV was introduced outside prospective clinical trials in our real-world, how we have to manage the toxicity.

First of all, it’s very important to have a multidisciplinary team. So we have to work in close contact with neurologists. They are the ones that have the best experience and know how to better explore these patients and identify really the neurotoxicity, which is subtle or which is grade one, probably better than us or better than me. So a multidisciplinary team is the most important thing. And then of course, basically this represents an early diagnosis of the complication. Then when the complication has already appeared, we need to know that it doesn’t make any sense. In fact, this is incorrect to continue giving brentuximab vedotin at the same dose. So we have two options here. The first option is to decrease the dose and there are clear guidelines on how we have to decrease the dose depending on the initial 100% dose that we were giving to the patient and the grade of neurological toxicity that the patient has developed, so that’s one possibility. And of course, if by decreasing the dose, the grade of neurotoxicity decreases, we are eventually allowed to go back to the initial dose to try to maximize the efficacy of the drug. Then the other option is to increase the time interval between brentuximab vedotin doses. So usually the drug is being given every three weeks, so we have the possibility to make it every four weeks. In addition to that, if with all these strategies, we see that peripheral sensory neuropathy, doesn’t go back to at least a grade one at some point, some patients need to stop the drug definitively, so with no option to reintroduce it.

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