brentuximab vedotin: clinical use

Prescribing considerations

• Treatment should be supervised by a clinician experienced in anticancer therapy.
• Assess baseline neuropathy, infection risk, tumour burden, hepatic function, renal impairment and concomitant medicines.
• Consider tumour lysis precautions in rapidly proliferating or high-burden disease.
• Record the product name and batch number for biological-medicine traceability.
• Evidence is less certain for CD30-positive cutaneous T-cell lymphoma subtypes other than mycosis fungoides and primary cutaneous anaplastic large cell lymphoma.

Contraindications and cautions

• Hypersensitivity to brentuximab vedotin or an excipient.
• Concurrent bleomycin because of pulmonary toxicity.

Monitoring

• Full blood count before each administration and prompt assessment of fever or infection.
• Baseline and routine liver-function testing.
• New or worsening sensory or motor neuropathy.
• Infusion reactions during and after administration, including delayed reactions.
• Pulmonary, neurological, gastrointestinal and severe cutaneous symptoms.
• Renal function and electrolytes when tumour lysis syndrome is a concern.
• Serum glucose if hyperglycaemia develops.
• Infusion site for extravasation.

Clinical pharmacology

A CD30-directed IgG1 antibody–drug conjugate linked to MMAE. Internalisation and lysosomal cleavage release MMAE, which binds tubulin, disrupts microtubules, arrests the cell cycle and promotes apoptosis. The antibody–drug conjugate has a terminal half-life of approximately four to six days; MMAE is metabolised mainly through CYP3A4/5 pathways.

Formulation and product differences

• Single-use powder for concentrate requiring aseptic reconstitution and dilution before intravenous infusion.
• Contains sodium and polysorbate 80; polysorbates may cause allergic reactions.
• The prepared infusion must use a dedicated intravenous line and must not contain other medicines.

Solution for infusion

Route: Intravenous

Strengths: 50 mg