Where does brentuximab vedotin fit into the management of patients with Hodgkin lymphoma?

Brentuximab vedotin is an antibody-drug conjugate that targets CD30 and links monomethyl auristatin E, a microtubule disrupting agent, to an anti-CD30 monoclonal antibody. A phase II study of brentuximab vedotin in relapsed/refractory classical Hodgkin lymphoma (cHL) showed an impressive overall response rate of 75 % with 34 % complete responses, and median remission duration of 20 months in complete responders. In addition, brentuximab vedotin has very modest toxicity in heavily pretreated patients, with reversible peripheral neuropathy being the most common side effect. Brentuximab vedotin received accelerated FDA approval in August 2011 for use as a salvage therapy in cHL following failure of at least two prior therapies. Brentuximab vedotin is the treatment of choice for patients relapsing after stem cell transplant and for patients refractory to standard salvage regimens pre-transplant. Because of high single-agent activity and limited side effects, brentuximab vedotin has emerged as an ideal drug to test in combination therapy for cHL. Current trials are examining the use of brentuximab vedotin in frontline combination regimens, as salvage therapy prior to stem cell transplant, and as adjuvant treatment post-transplant. Such studies will help clarify the optimal use of brentuximab vedotin in the treatment paradigm for Hodgkin lymphoma.