Brentuximab vedotin in anaplastic large cell lymphoma

Introduction: Brentuximab vedotin, a novel anti-CD30 antibody-drug conjugate, delivers a cytotoxic agent into CD30(+) cells. CD30 expression is characteristic of anaplastic large cell lymphoma (ALCL) and Hodgkin lymphoma (HL). Areas covered: We reviewed data on brentuximab vedotin, focusing on ALCL and discuss pharmacology, clinical trials leading to approval and future research directions. Systemic ALCL, 3% of adult NHL, is characterized by large anaplastic CD30+ cells. The fusion protein NPM-ALK, when present in systemic ALCL, confers better prognosis, although even ALK- patients with IPI score >= 3 are high-risk. For patients with systemic ALCL, 25 - 45% relapse after frontline therapy, and > 50% of patients will relapse following high-dose chemotherapy with autologous stem-cell support. There has been no standard therapy for relapsed/refractory systemic ALCL. Brentuximab vedotin, combines a monoclonal antibody targeted to CD30 with a microtubule disrupting agent and was recently approved for treatment of patients with systemic ALCL that is refractory or relapsed after at least one multiagent chemotherapy regimen. Expert opinion: Brentuximab vedotin provides targeted therapy to CD30(+) lymphomas, including ALCL and HL, with high response rates and manageable toxicity, predominantly myelosuppression and peripheral neuropathy.