Brentuximab (Intravenous)

Also known by its trade name, Adcetris, Brentuximab is an antineoplastic (anti-cancer) chemotherapy drug. It is administered by injection and is used to treat blood cancers such as Hodgkin Lymphoma and systemic anaplastic large cell lymphoma.

Overview

When administered as part of a regular treatment routine as directed and supervised by your doctor, Brentuximab can help destroy blood cancers such as Hodgkin Lymphoma and systemic anaplastic large cell lymphoma. It is categorized as an "antineoplastic agent and a monoclonal antibody"and is an anti-cancer chemotherapy drug that must be administered intravenously. This categorization means that it consists of antibodies that are created by identical immune cells that are all clones of one special parent cell. It also means that the medication includes chemotherapy.

When it comes to blood cancer, Lymphoma is the most common type. It has two main forms known as Hodgkin lymphoma (HL) and non-Hodgkin lymphoma. Lymphoma takes place when the cells or our immune system (a type of white blood cell called lymphocytes) become bigger and spread by uncontrollably multiplying. Grouped into two key categories known as B cells and T cells, these cancerous lymphocytes may travel to lots of areas in the body which can include the lymph nodes, bone marrow, spleen, blood and form a mass (a tumour).

Both of these types of cancer are usually diagnosed by an enlarged lymph node. They are a very treatable cancer that when caught early, has a highly likely chance of being cured.

Cancer known as systemic anaplastic large cell lymphoma (ALCL), is a subtype of T-cell lymphoma and an uncommon type of non-Hodgkin lymphoma. It actually makes up 16% of all T-cell lymphomas and can be harder to notice than other blood cancers due to its lack of physical symptoms such as lumps. Because of this, systemic anaplastic large cell lymphoma is usually treated as an aggressive form of lymphoma and is diagnosed later than Hodgkin's or non-Hodgkin's. Systemic anaplastic large cell lymphomas are split into two groups depending on whether an abnormal form of a protein (protein CD30) has formed on the surface of the cells. For patients who test positive for having the abnormal form of protein, their cancer tends to respond well to chemotherapy. There is a much higher chance of the disease relapsing in those that test negative.

Brentuximab is used to treat those who have either Hodgkin lymphoma or systemic anaplastic large cell lymphomas and who have not responded well to previous treatment. For those with Hodgkin lymphoma, this may be the failure of an autologous stem cell transplant, or the inability to have an autologous stem cell transplant in the first place and the failure of a minimum of two multi-agent chemotherapy regimens. For those with systemic anaplastic large cell lymphoma, you will be treated with brentuximab after a minimum of one prior multi-agent chemotherapy regimen is unsuccessful.

The brentuximab dosage is in a powder for a solution and is administered by an infusion to the vein by an IV. Brentuximab is a targeted treatment that will stick to the CD30 protein that sits on top of the cancer cell and it will deliver the drug directly into the cell. Here, the brentuximab interferes with the structural network of the cell which stops the cell from being able to spread by dividing and copying itself. This eventually results in them being destroyed by your body. The quantity of brentuximab that you will be given will depend on a number of factors including your general health, any other illnesses or problems, the type of cancer that you have and your weight. In all cases of using brentuximab, it will be prescribed, planned and managed by your doctor.

Conditions treated

  • Blood cancers including:
  • Hodgkin lymphoma
  • Systemic anaplastic large cell lymphoma.

Type of medicine

  • Antineoplastic agent and a monoclonal antibody.

Side effects

Due to the nature and continued use of brentuximab, it is highly possible that you will experience some side effects. Some of these side effects won't need medical attention and are likely to go away during your treatment and once your body adjusts to the medicine. These side effects may include a decreased appetite or weight, constipation, difficulty with moving, muscle spasms or stiffness, hair loss or thinning, night sweats, pain in the arms or legs, insomnia, nausea, dry skin or a rash. If you find that any of these side effects are persistent or worrisome, discuss them with your doctor.

For most patients taking this medication, severe side effects are unlikely. However, if you notice any adverse reaction including black, tarry stools, bleeding gums, blood in urine or stools, lower back or side pain, difficulty urinating, unusual bleeding or bruising and vomit that looks like coffee grounds, you must contact a healthcare professional right away. These are all signs of stomach or bowel problems that must be treated as soon as possible.

The sensation of burning, numbness, tingling, or pain in the arms, hands, legs, or feet are all indicators of a serious condition called peripheral neuropathy and must be seen by a doctor right away.

In very rare cases, this medicine can cause two rare and serious reactions. Tumor lysis syndrome is one that your doctor may give you preventative medication for, depending on your circumstances. If you notice a decrease in urine amount, stiffness, swelling, joint pain, lower flank pain, sudden weight gain, swelling of the feet or lower legs, or abnormal tiredness or weakness, it is key that you contact your doctor immediately.

Another, very rare reaction to brentuximab is the brain infection, progressive multifocal leukoencephalopathy (PML). Get to a hospital and contact your doctor immediately if you have vision changes, loss of coordination, clumsiness, memory loss, difficulty speaking or understanding others or weakness in the legs.

If you happen to notice any issues with breathing, chest pain or your throat such as a loss of voice, swelling of the lips or throat, difficult and laboured breathing or a tight feeling in your chest, it is important that you seek medical advice immediately. Amongst other things, these could be signs of a possible allergic reaction.

Brentuximab can also cause severe skin reactions that are unpleasant and painful. Make an appointment with your doctor if you experience redness, rashes, blistering, peeling or loosening of the skin.

This is not a full list of side effects or symptoms that you may experience when taking brentuximab. Before beginning your course of treatment, make sure to read all the documentation that you will be given to finding a comprehensive list of side effects.

Dosage

The dose of brentuximab that you will be given will be dependant on a number of factors. These will include your current state of health, the type of cancer that you have, your age and your weight.

This will all be decided once you have completed a range of tests and your doctor has been able to draw up an informed conclusion.

The brentuximab will be administered intravenously, which means that it will be delivered directly into your bloodstream. This is usually done by having a cannula inserted into a vein in each arm. In some cases, you may be given brentuximab through a central line, a long a PICC line or a porta cloth. The usual duration for each treatment is 30 minutes.

It is important that you ask your doctor any questions that you have regarding dosage and administration method before you begin your treatment.

Interactions

Before starting your course of brentuximab it is vital that you let your doctor know of any other medications that you may be taking or whether you have any immunizations planned. Don't miss out any herbal remedies, over-the-counter medicines or supplements that you are also taking too, as these have the potential to interact with the medication. Bleomycin or Blenoxane, is a medicine of particular importance to your doctor, as it should not be taken with brentuximab. If you are taking bleomycin, it is vital that you communicate this to your doctor as it can cause serious side effects such as difficulty in breathing.

It is also important that you make sure your doctor is aware of any current or past health problems that you may have. Brentuximab can interact with lung problems, exacerbating them or creating new issues.

Alongside this, dietary and lifestyle factors should always be factored into your treatment plan. Alcohol may hinder treatment or emphasise certain side effects whilst smoking or eating certain foods may also have a negative impact. It is important to discuss the effects of food, alcohol and tobacco with your doctor so that they can help manage your treatment in the best way possible.

Warnings

It is important to inform your doctor of any health problems that you have before beginning your treatment with brentuximab. This is because certain conditions may interact with the medication and become exasperated or have a negative effect on the medicine.

There are many side effects involved with brentuximab, and it's important that you have a good understanding and knowledge of the possible adverse reactions that you may experience. Some of these can be managed or alleviated with the help and direction of your healthcare professional, but others can be serious and even life-threatening. As with all new medication, make sure to keep a close eye on any adverse reactions you may be having, and don't hesitate to contact a healthcare professional if you feel concerned in any way.

Brentuximab can have severe implications for unborn babies and pregnancy, so it is important to be as open and honest as you can be with your doctor regarding this. It is advised that anyone on this medication uses contraception during their treatment, as brentuximab is extremely harmful to fetuses. It is also recommended that contraception is used for at least 6 months from the last dose of brentuximab as the medicine may still be in your system.

It is important that patients do not breastfeed when on this medication or in the months after, as it can prove to have adverse reactions to an infant. It is important that you discuss your treatment and children with your doctor before starting it.

Men who plan to have children and who are taking brentuximab will have to consider a number of options and discuss the effects of the medication with a doctor. Although it doesn't happen to everyone, there is a chance that some men can become infertile after finishing their treatment.

Storage

It is likely that you will never come into contact with brentuximab as it will only ever be administered in a hospital environment, by trained healthcare professionals. Brentuximab should always be kept in a safe, sterile medical environment that is at the correct temperature and away from direct sunlight. It must be disposed of immediately if its packaging appears to be damaged or tampered with and it should only ever be handled by doctors or healthcare professionals.

Summary

Brentuximab is a targeted treatment that can kill cancerous cells by destroying them from the inside. It is a treatment process that will be difficult for most, with a high likelihood of side effects. However, as part of a well-managed treatment plan and strong communication links with your healthcare team, brentuximab can make a vast difference to you and your family's life, by giving you a longer, healthier future and an increased lifespan.

It is essential that you have a good understanding of the side effects that this medication may cause, and that you have people or healthcare professionals close by, who may be able to offer support when necessary. Side effects including fatigue, fever, upper respiratory infections, nausea and low blood pressure affect over 30% of brentuximab users, so must be factored into your treatment plan. For many, these side effects don't cause enough impact to stop their everyday activities, but some days may be more difficult.

When taking brentuximab, it will require lots of visits to your doctor and blood tests. It is important that you factor this into your thought process and plan before beginning treatment, This is because, during your treatment, you may feel weaker or may be experiencing unpleasant effects. Also be prepared to make changes to your lifestyle, diet and routine. This will all contribute to your treatment being effective and causing the least impact on your life.

It is also important to discuss any birth control that you may be taking, as well as your options if you plan on having children in the near future. Brentuximab can cause infertility in men, which should be thought about in depth before beginning treatment. Your doctor will be able to provide any advice that may help you come to a decision about your treatment and parenthood.

To achieve the best results from this medication, it requires plenty of commitment, patience and persistence. However, on successful completion, you will be able to look towards a longer and more stable future that can have a huge impact on yourself, family and friends.

Resources
Last Reviewed:
December 23, 2017
Last Updated:
April 04, 2018