Dr. Fanale on Frontline Brentuximab in Lymphoma

Michelle A. Fanale, MD, Associate Professor, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses a phase I trial that examined the frontline administration of brentuximab vedotin (Adcetris) for patients with subtypes of lymphoma.

The trial enrolled 39 patients with high-risk systemic anaplastic large cell lymphoma (sALCL) and other CD30-positive mature T- and NK-cell lymphomas. The trial was divided into 3 arms. The first arm received 2 cycles of brentuximab (1.8 mg/kg) followed by 6 cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) at the standard dose. The remaining two arms received 6 cycles of brentuximab (1.8 mg/kg) in combination with standard-dose CHP (cyclophosphamide, doxorubicin, prednisone) for 6 cycles. Those who responded received subsequent single-agent brentuximab for up to 10 cycles.

Fanale believes that the most astounding finding from the trial is that all patients entered into remission. At the initial follow up of approximately 9 months, 26 patients had been analyzed from Arms 2 and 3. In all, 23 patients (88%) achieved a complete response and 100% experienced an objective response. Fanale notes that all non-sALCL patients experienced a complete response, specifically those with T-cell lymphomas.

The toxicity profile was manageable in the trial with the occurrence of some peripheral neuropathy, Fanale notes. Furthermore she adds that brentuximab concurrently with CHP did not seem to make side effects worse when compared to sequential dosing with CHOP.

A phase III study is planned to compare CHOP to the combination of brentuximab and CHP in the frontline treatment of mature T-cell lymphomas.