Generic Name brentuximab vedotin

Brand Name Adcetris

Drug Classification Antineoplastics, Antimicrotubular, Anti-Nectin-4
Monoclonal Antibodies, Anti-CD30 Monoclonal Antibodies

Suggested Dose:  Previously untreated Stage III or IV Classical

Hodgkin Lymphoma:
- 1.2 mg/kg up to a maximum of 120 mg in
combination with chemotherapy

 Classical Hodgkin Lymphoma Consolidation:

- 1.8 mg/kg up to a maximum of 180 mg

 Relapsed Classical Hodgkin Lymphoma:

- 1.8 mg/kg up to a maximum of 180 mg

 Relapsed Primary Cutaneous Anaplastic Large

Cell Lymphoma or CD30-expressing Mycosis
Fungoides:
- 1.8 mg/kg up to a maximum of 180 mg

 Relapsed Systemic Anaplastic Large Cell

Lymphoma:
- 1.8 mg/kg up to a maximum of 180 mg

Mode Of Action Brentuximab vedotin is made up of three components: a

chimeric human-murine IgG1 that specifically targets
CD30, a microtubule-disrupting drug called monomethyl
auristatin E (MMAE), and a protease-susceptible linker that
binds the antibody and MMAE. Brentuximab vedotin is
 able to target tumor cells that express CD30 on their
surface thanks to the IgG1 antibody and then enters the
cell. The linker is cleaved once the drug is inside, releasing
MMAE, which binds and breaks the microtubule network
Label.

This medication contains a chimeric IgG1 antibody

that is directed towards CD30. A linker covalently attaches
MMAE to the antibody. The anticancer effect of Adcetris
appears to be due to ADC binding to CD30-expressing
cells, internalization of the ADC-CD30 complex, and
proteolytic cleavage of MMAE. The binding of MMAE to
tubulin disrupts the microtubule network within the cell,
causing malignant cells to enter a state of cell cycle arrest
and apoptosis or cell death.

Indication  Previously untreated Stage III/IV cHL

- Adult patients who had previously received no
treatment in Stage III/IV classical Hodgkin
lymphoma (cHL) combined with doxorubicin,
vinblastine, and dacarbazine.

 cHL post-auto-HSCT consolidation

- Adults with cHL who are at a high risk of
recurrence or progression as a result of
autologous hematopoietic stem cell
transplantation (auto-HSCT) consolidation.

 Relapsed cHL
- Adults with cHL who have failed auto-HSCT or
who have failed at least two prior multi-agent
chemotherapy regimens and are not auto-
HSCT candidates.
  Previously untreated sALCL or other CD30-
expressing PTCL
- Adult patients who have previously received no
treatment to systemic anaplastic large cell
lymphoma (sALCL) or other CD30-expressing
peripheral T-cell lymphomas (PTCL), including
angioimmunoblastic T-cell lymphoma and
PTCL not otherwise described, receiving
cyclophosphamide, doxorubicin, and
prednisone in combination.

 Relapsed sALCL
- Adults with sALCL who have previously failed
at least one multi-agent chemotherapy course

 Relapsed pcALCL or CD30-expressing MF

- Adults with primary cutaneous anaplastic large
cell lymphoma (pcALCL) or CD30-expressing
mycosis fungoides (MF) who have previously
had systemic therapy.

Contraindication  Patients who have previously experienced an

allergic reaction to Adcetris or its components
 Patients who take bleomycin
Side Effects numbness, tingling, fever, low blood cells count, nausea,
vomiting, diarrhea, constipation, and tiredness
Adverse Effects Peripheral neuropathy, fatigue, nausea, diarrhea,
neutropenia, upper respiratory tract infection, pyrexia,
constipation, vomiting, alopecia, decreased weight,
abdominal pain, anemia, stomatitis, lymphopenia, and
mucositis.
Drug Interaction 1. Bleomycin – may cause pulmonary toxicity such
as interstitial infiltration and/or inflammation
2. BCG vaccine - may be at risk for developing an
infection from the vaccine or have a reduced
response to the vaccine.
 3. Amprenavir - may increase the blood levels of
brentuximab vedotin which could also increase the
risk and/or severity of side effects such as nausea,
vomiting, diarrhea, nerve damage, and impaired
bone marrow function resulting in low numbers of
different types of blood cells.
4. Acetaminophen - The metabolism of Brentuximab
vedotin can be increased when combined with
Acetaminophen.
5. Trastuzumab - Trastuzumab may increase the
neutropenic activities of Brentuximab vedotin.
6. Quinestrol - Quinestrol may increase the
thrombogenic activities of Brentuximab vedotin.
7. Morphine - The serum concentration of
Brentuximab vedotin can be increased when it is
combined with Morphine.
8. Moderna COVID-19 Vaccine - The therapeutic
efficacy of Moderna COVID-19 Vaccine can be
decreased when used in combination with
Brentuximab vedotin.
9. Human immunoglobulin G - The risk or severity
of adverse effects can be increased when Human
immunoglobulin G is combined with Brentuximab
vedotin.
10. Fingolimod - Brentuximab vedotin may increase
the immunosuppressive activities of Fingolimod.
Nursing Responsibilities 1. Avoid the use of brentuximab vedotin in patients
with severe renal impairment (creatinine clearance
(CrCl) less than 30 mL/min)
R: The incidence of grade 3 or higher adverse
events and death was higher in patients with
severe renal impairment compared with patients
with normal renal function (CrCl greater than 80
mL/min) who takes the drug.
2. Evaluate patients who develop new neurological,
cognitive, or behavioral signs and symptoms such
as changes in mood or behavior; confusion;
memory impairment; changes in vision, speech, or
walking; and/or decreased strength or weakness on
one side of the body. Hold therapy if PML is
suspected; discontinue brentuximab in patients with
confirmed PML.
R: Fatal cases of progressive multifocal
leukoencephalopathy (PML), caused by the John
Cunningham virus (JC virus), have been reported
with brentuximab therapy

3. Closely monitor patients during treatment for signs

and symptoms of bacterial, fungal, or viral infection.
R: Opportunistic infections and other serious
infections, including pneumonia, bacteremia, and
sepsis have been reported with the given drug
therapy

4. Monitor patients for signs of Tumor lysis syndrome

or TLS (e.g., serum electrolytes, uric acid, serum
creatinine) prior to and during therapy
R: Patients with rapidly proliferating tumors and/or
a high tumor burden may have an increased risk of
developing TLS as there are also some reports of
patients having TLS when receiving brentuximab
vedotin

5. Monitor patients for symptoms of neuropathy (e.g.,

hypoesthesia, hyperesthesia, paresthesia,
discomfort, burning sensation, neuropathic pain, or
weakness)
 R: Therapy interruption, dosage reduction, or
discontinuation may be necessary in patients who
develop new or worsening peripheral neuropathy
as there is a possibility for the patient to develop it
while taking the drug

6. Evaluate patients who develop new or worsening

pulmonary symptoms; hold brentuximab until
symptoms improve
R: Severe noninfectious pulmonary toxicity (e.g.,
pneumonitis, interstitial pulmonary disease, acute
respiratory distress syndrome) has been reported
with brentuximab therapy where some cases were
noted to be fatal

7. Monitor patients closely for symptoms of a reaction

during the brentuximab infusion. Immediately and
permanently discontinue therapy if anaphylaxis
occurs.
R: Possible anaphylaxis may occur as there have
been reports of infusion-related reactions when
taking brentuximab vedotin therapy.

8. Instruct female patients to avoid becoming

pregnant when receiving brentuximab.
R: The drug may cause fetal harm based on its
mechanism of action from animal studies.

9. Advise male patients with female partners to use

effective contraception during therapy and for at
least 6 months after therapy.
R: There is a risk for male-mediated teratogenicity
or it could cause male infertility based on animal
studies
 10. Monitor serum glucose; if hyperglycemia develops,
administer antihyperglycemic medications as
clinically indicated.
R: Serious events of hyperglycemia, such as new-
onset hyperglycemia, exacerbation of pre-existing
diabetes mellitus, and sometimes fatal ketoacidosis
have been reported in brentuximab-treated
patients.

Bibliography:
Drugs.com. (2020). Adcetris. Retrieved from: https://www.drugs.com/adcetris.html

DrugBank Online. (2021). Brentuximab vedotin. Retrieved from:

https://go.drugbank.com/drugs/DB08870
Marshall, H. (2020). Adcetris (brentuximab vedotin). Retrieved from:
https://www.medicalnewstoday.com/articles/adcetris#interactions
Medscape. (n.d.). Brentuximab vedotin (rx). Retrieved from:
https://reference.medscape.com/drug/adcetris-brentuximab-vedotin-999680#4
RxList. (2021). Adcetris. Retrieved from: https://www.rxlist.com/adcetris-
drug.htm#description
Seagen.com. (n.d.). Adcetris (brentuximab vedotin)/ for injection. Retrieved from:
https://www.seagen.com/medicines/adcetris