|Licence data||US FDA:|
|Pregnancy cat.||D (US)|
|Legal status||℞-only (US)|
|Synonyms||SGN-35, previously cAC10-vcMMAE|
|Mol. mass||149.2–151.8 kDa|
|(what is this?)|
Brentuximab vedotin (INN, trade name Adcetris) is an antibody-drug conjugate (ADC) directed to the protein CD30, which is expressed in classical Hodgkin lymphoma (HL) and systemic anaplastic large cell lymphoma (sALCL).
On 28 February 2011 Seattle Genetics submitted a Biologics License Application or BLA to the U.S. Food and Drug Administration (FDA) for the use of brentuximab vedotin in relapsed or refractory Hodgkin's lymphoma and relapsed or refractory systemic anaplastic large cell lymphoma.
The drug was granted accelerated approval by the U.S. Food and Drug Administration on August 19, 2011 for relapsed HL and relapsed sALCL and conditional Marketing authorization from the European Medicines Agency in October 2012 for relapsed or refractory HL and relapsed or refractory sALCL.
Antibody-drug conjugates or ADCs represent a therapeutic application that combines the properties of monoclonal antibodies (mAbs) with the cell killing activity of cytotoxic small molecule drugs. The key components of antibody-drug conjugates include a monoclonal antibody, a stable linker and a cytotoxic (anticancer) agent. Monoclonal antibodies are attached to biologically active drugs by chemical linkers with labile bonds. By combining the targeting of mAbs with the cancer-killing ability of cytotoxic drugs, antibody-drug conjugates allow discrimination between healthy and diseased tissue.
Brentuximab vedotin consists of the chimeric monoclonal antibody brentuximab (cAC10) (which targets the cell-membrane protein CD30) linked to cathepsin cleavable linker (valine-citrulline), para-aminobenzylcarbamate spacer three to five units of the antimitotic agent monomethyl auristatin E (MMAE, reflected by the 'vedotin' in the drug's name). The peptide-based linker bonds the antibody to the cytotoxic compound in a stable manner so the drug is not easily released from the antibody under physiologic conditions to help prevent toxicity to healthy cells and ensure dosage efficiency. The peptide antibody-drug bond facilitates rapid and efficient drug cleavage inside target tumor cell. The antibody cAC10 part of the drug binds to CD30 which often occurs on diseased cells but rarely on normal tissues.The antibody portion of the drug attaches to CD30 on the surface of malignant cells, delivering MMAE which is responsible for the anti-tumour activity. Once bound Brentuximab Vedotin is internalised by endocytosis and thus selectively uptaken by targeted cells. The vesicle containing the drug is fused with lysosomes and lysosomal cysteine proteases, particularly cathepsin B start to break down valine-citrulline linker and MMAE is no longer bound to the antibody and is released directly into tumor environment. 
In a 2010 clinical trial, 34% of patients with refractory Hodgkin Lymphoma achieved complete remission and another 40% had partial remission. Tumor reductions were achieved in 94% of patients. In ALCL, 87% of patients had tumors shrink at least 50% and 97% of patients had some tumor shrinkage. Reports from the 55th Annual Meeting of the American Society of Hematology (2013) showed interim results from a Phase II, open-label, single-arm study designed to evaluate the antitumor activity of brentuximab vedotin in relapsed or refractory CD30-positive NHL, including B-cell neoplasms. These results demonstrated that single-agent brentuximab vedotin induced a 42% objective response rate and manageable safety profile among advanced diffuse large B-cell lymphoma patients. An ongoing phase III trial funded by Millennium Pharmaceuticals has the objective of comparing ABVD (a combination of chemotherapy drugs doxorubicin, bleomycin, vinblastine, and dacarbazine used for treatment of Hodgkin lymphoma) and brentuximab vedotin in combination with AVD (doxorubicin, vinblastine, and dacarbazine) for treatment of classical Hodgkin lymphoma. A phase I study shows that a high number of patients using combination of brentuximab vedotin and ABVD experienced pulmonary toxic effects, however 0 patients had pulmonary toxic effects when treated with brentuximab vedotin and AVD, proving that bleomycin- brentuximab vedotin interaction caused these effects. 24 out of 25 patients treated with brentuximab vedotin and AVD achieved complete remission but further studies are required to find progression-free survival time and measure the effectiveness of this new combination therapy. Brentuximab vedotin is also investigated as a substitute for vincristine (another mitotic inhibitor which prevents tubulin polymerization) which is used in non-Hodgkin lymphoma chemotherapy regimen CHOP (consisting of cyclophosphamide, hydroxydaunorubicin, vincristine, prednisone or prednisolone). A phase III clinical trial is currently comparing the two combination therapies (CHOP and CHP- brentuximab vedotin) with estimated completion in December 2017
Serious adverse events
Brentuximab vedotin was studied as monotherapy in 160 patients in two phase II trials. Across both trials, the most common adverse reactions (≥20%), regardless of causality, were chemotherapy-induced peripheral neuropathy (a progressive, enduring and often irreversible tingling numbness, intense pain, and hypersensitivity to cold, beginning in the hands and feet and sometimes involving the arms and legs), neutropenia (an immune system impairment), fatigue, nausea, anemia, upper respiratory tract infection, diarrhea, pyrexia, rash, thrombocytopenia, cough and vomiting.
Three to five units of MMAE are attached to the monoclonal antibody (MAB) brentuximab via the spacer paraaminobenzoic acid (marked green), a cathepsin-cleavable linker (Cit=citrulline, Val=valine, marked blue), and an attachment group consisting of caproic acid and maleimide (marked brown).
Development and marketing collaboration
Brentuximab vedotin is marketed as Adcetris. Seattle Genetics and Millennium Pharmaceuticals/Takeda are jointly developing brentuximab vedotin. Under the terms of the collaboration agreement, Seattle Genetics has U.S. and Canadian commercialization rights and the Takeda Group has rights to commercialize in the rest of the world. Seattle Genetics and the Takeda Group are funding joint development costs for brentuximab vedotin on a 50:50 basis, except in Japan where the Takeda Group will be solely responsible for development costs.
- Fierce Biotech: Seattle Genetics Submits BLA to FDA for brentuximab vedotin in relapsed or refractory hodgkin lymphoma and systemic ALCL
- U.S. FDA: Brentuximab Vedotin (marketed as Adcetris) Information
- EMA/European Medicines Agency: EPAR summary for the public for Adcetris/brentuximab vedotin
- Genetic Engineering & Biotechnology News: Seattle Genetics’ Antibody-Drug Conjugate Receives FDA Okay to Treat Lymphomas
- ADC Review / Journal of Antibody-drug Conjugates: Stable Linker (technologies), May 23, 2013
- ADC Review / Journal of Antibody-drug Conjugates: Cytotoxic Agents, May 23, 2013
- ADC Review / Journal of Antibody-drug Conjugates: Monomethyl auristatin E (MMAE), May 23, 2013
- Seattle Genetics: Clinical Trials with brentuximab vedotin (SGN-35)
- Francisco, J. A.; Cerveny, C. G.; Meyer, D. L.; Mixan, B. J.; Klussman, K.; Chace, D. F.; Rejniak, S. X.; Gordon, K. A.; Deblanc, R.; Toki, B. E.; Law, C. L.; Doronina, S. O.; Siegall, C. B.; Senter, P. D.; Wahl, A. F. (2003). "CAC10-vcMMAE, an anti-CD30-monomethyl auristatin E conjugate with potent and selective antitumor activity". Blood 102 (4): 1458–1465. doi:10.1182/blood-2003-01-0039. PMID 12714494.
- Christos Vaklavas and Andres Forero-Torres; Safety and efficacy of brentuximab vedotin in patients with Hodgkin lymphoma or systemic anaplastic large cell lymphoma Therapeutic Advances in Hematology (August 2012) vol. 3 no. 4: 209-225doi: 10.1177/2040620712443076
- ClinicalTrials.gov NCT00848926 A Pivotal Open-Label Trial of Brentuximab Vedotin for Hodgkin Lymphoma
- Seattle Genetics and Millennium Report Positive Data from Pivotal Trial of Brentuximab Vedotin (SGN-35) in Relapsed or Refractory Hodgkin Lymphoma at 2010 Annual Meeting of the American Society of Hematology (ASH) (Corporate Press Release)
- Minyanville Business News: Is Seattle Genetics the Next Big Thing?, December 2, 2010
- Jeff P. Sharman (21 October 2013). "A Phase 2 Study Of Brentuximab Vedotin In Patients With Relapsed Or Refractory CD30-Positive Non-Hodgkin Lymphomas: Interim Results In Patients With DLBCL and Other B-Cell Lymphomas". Blood 122 (21): 848.
- ClinicalTrials.gov NCT01421667 A Study of Brentuximab Vedotin in Relapsed or Refractory Non-Hodgkin Lymphoma
- "Brentuximab Vedotin Shows 42% Objective Response Rate in Patients with Relapsed or Refractory Diffuse Large B-cell Lymphoma, Study Shows". ADC Review / Journal of Antibody-drug Conjugates. 10 December 2013.
- Anas Younes, Joseph M. Connors, Steven I. Park, Michelle Fanale, Megan M. O'Meara, Naomi N. Hunder et al; Brentuximab vedotin combined with ABVD or AVD for patients with newly diagnosed Hodgkin's lymphoma: a phase 1, open-label, dose-escalation study The Lancet Oncology, (December 2013) Volume 14, Issue 13, 1348 - 1356doi:10.1016/S1470-2045(13)70501-1
- A Randomized, Double-blind, Placebo-controlled, Phase 3 Study of Brentuximab Vedotin and CHP (A+CHP) Versus CHOP in the Frontline Treatment of Patients With CD30-positive Mature T-cell Lymphomas trial identifier: NCT01777152
- Highlights of Prescribing Information (US)/Adcetris (brentuximab vedotin) for Injection (2012)
- A. Klement (13 May 2013). "Sprunginnovation beim Hodgkin-Lymphom: Adcetris". Österreichische Apothekerzeitung (in German) (10/2013): 68.
- Onco'Zine - The International Cancer Network: European Medicines Agency Accepts Brentuximab Marketing Authorization Application, June 27, 2011