Objective: Patients with relapsed/refractory CD30 positive lymphomas have relatively poor outcomes, with reported 3–5-year overall survival (OS) of only 30–50%. Mycosis fungoides (MF) and its leukemic variant, Sézary syndrome (SS), are the most common subtypes of cutaneous T cell lymphoma (CTCL). Brentuximab vedotin (BV) is an antibody-drug conjugate linking a CD30 antibody to four molecules of the microtubule inhibitor monomethyl auristatin E (MMAE), which has multiple proposed mechanisms of action BV is FDA-approved for relapsed Hodgkin's lymphoma (HL) and systemic anaplastic large cell lymphoma (sALCL). National Comprehensive Cancer Network guidelines have already incorporated BV as a primary treatment option in multifocal primary cutaneous anaplastic large cell lypmhoma (pcALCL) and MF.
Methodology: Between January 2018 and June 2020, 10 patients with CD30+ cutaneous T cell lymphoma (MF and pcALCL) who were treated with BV are evaluated in our study. One cycle of BV typically involves 1.8mg/kg being administered intravenously once every 3 weeks. We detail our experience with BV and the position of BV in our treatment methods for CTCL.
Results: Ten patients (6 male and 4 female) have received BV in our center. Median age at time of commencing brentuximab was 54.5 years (range 34–72 years), 80% of patients had experienced at least one prior line of chemotherapy (range 0–2). Six patients with Mycosis Fungoides (MF) and large cell transformation (LCT) and one with high burden Sezary Syndrome (SS) and 3 patients with multifocal primary cutaneous anaplastic large cell lymphoma (pcALCL). The median follow-up was 21.5 (range: 4–60) months from the date of diagnosis. Adverse events were grade 1–2 peripheral neuropathy (40%) and gastro-intestinal disturbances (10%). Peripheral neuropathy resolved by discontinuation of therapy. All there pcALCL patients achieved complete remission after 5 cycle of BV. One patient with MF had progressive disease due to nodal involvement and one died of fungal pneumonia after 2 cycles of BV and could not evaluated for disease response.
Conclusion: BV has proven efficacy in both CD30- expressing MF, pcALCL. Same as previous studies, CR could be achieved more frequently in pcALCL than MF in our study. BV is found significantly higher response rates compared to traditional agents like methotrexate or bexarotene and 75% of patients had underwent these therapies before BV. In summary, BV is a promising agent for relapsed refractory CTCL patients with durable remission.
