How safe and effective is combined brentuximab vedotin and bendamustine in patients with relapsed/refractory HL?

This study determined the safety and effectiveness of combined brentuximab vedotin (Adcetris) and bendamustine (Treanda) for relapsed or refractory (did not respond to treatment) Hodgkin’s lymphoma (HL). The study concluded that this combination is safe and effective, even for patients who already received intense anticancer therapies.

The most common chemotherapy regimen for Hodgkin’s lymphoma (HL) patients is ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine). If the disease does not respond to chemotherapy (is refractory), a stem cell transplant (SCT) is used. For these patients, achieving a complete response (tumor disappearance) before SCT is the most important factor for a good prognosis. The combination treatment in the current study may increase the chances of a complete response before additional therapies like SCT.

Brentuximab vedotin is a monoclonal antibody. This type of treatment binds to cancer cells, leading to cancer cell death. Bendamustine is an alkylating agent. This type of treatment damages the DNA inside cancer cells, leading to cancer cell death. Patients given either of these drugs do not show improved progression-free survival (time from treatment until disease progression or death from any cause) compared to other treatments. It is not clear whether combining these drugs is better than either drug alone.

The current study investigated the combination of brentuximab vedotin and bendamustine. This study involved 65 patients with either HL (98%) or anaplastic large T-cell lymphoma (2%). All patients received the combination treatment. In the first phase, the appropriate doses were determined. In the second phase, all patients were assigned to the same dose. Only 57% of patients received the recommended dose during the second half of the study.

71% of all patients showed an overall response (tumor disappearance or shrinkage). 32% of patients showed tumor disappearance (complete response) and 38% of patients showed tumor shrinkage (partial response). 78% of patients who received the recommended dose showed an overall response. Of these, 43% showed a complete response and 35% showed a partial response.

For patients during the first half of the study, the average overall survival (time from treatment until death from any cause) rate was 43.3 months. The progression-free survival rate was 7.5 months. For patients in the second half of the study (57%), average overall and progression free survival was not yet met at the end of the study.

Serious side effects reported in the frist phase included low red blood cell levels (18%), low platelet levels (14%), and low white blood cell levels (11%). In phase two serious side effects included lung infections (14%) and low levels of white blood cells (35.1%). 

This study concluded that the combination of brentuximab vedotin and bendamustine is safe and effective for patients with relapsed or refractory HL.

The current study received funding from Seattle Genetics, the company developing brentuximab vedotin. The authors report that Seattle Genetics had no role in conducting or designing the study, or writing the report. Additional clinical trials are needed to further compare the combination treatment to other regimens.

If you have relapsed or refractory Hodgkin’s lymphoma, talk to your care team about combining brentuximab vedotin and bendamustine as a second-line therapy. If you are 65 years or older and at risk of neutropenia, discuss taking a G-CSF (granulocyte colony stimulating factor) to increase your white blood cell levels.