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Szabo SM, Hirji I, Johnston KM, Juarez-Garcia A, Connors JM. Treatment patterns and costs of care for patients with relapsed and refractory Hodgkin lymphoma treated with brentuximab vedotin in the United States: A retrospective cohort study. PLoS One 2017; 12:e0180261. [PMID: 28991893 PMCID: PMC5633181 DOI: 10.1371/journal.pone.0180261] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 06/13/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Although brentuximab vedotin (BV) has changed the management of patients with relapsed or refractory Hodgkin lymphoma (RRHL), little information is available on routine clinical practice. We identified treatment patterns and costs of care among RRHL patients in the United States (US) treated with BV. METHODS A retrospective observational study of adults initiating BV for RRHL from 2011-2015, with ≥6 months of data prior to and following BV initiation, was conducted. Treatments were classified based on dispensations and chemotherapy administration. Median total and monthly costs were estimated based on all-cause healthcare resource use in 2015 US dollars (USD). RESULTS The cohort comprised 289 patients (59% male; mean age at diagnosis, 42 years) with a mean follow-up of 250 weeks. Eleven percent had BV salvage therapy prior to ASCT, and 32% had BV for a relapse post-ASCT. 43% received treatment post-BV, most commonly allogeneic stem cell transplant (SCT) and bendamustine (both 10.2%). Median (IQR) total costs from BV initiation to censoring were 294,790 (142,110-483,360) USD; and were highest among those treated with BV prior to ASCT (up to 421,900 [300,940-778,970] USD). Median monthly costs were almost 20,000 USD per month, and up to 25,000 USD per month among those with BV and ASCT. Medications were the greatest driver of median monthly costs. CONCLUSIONS Median total all-cause costs were almost 300,000 USD, and median monthly costs approximately 20,000 USD, per patient treated. Patients requiring treatment following BV continue to incur high costs, highlighting the economic burden associated with managing patients in the RRHL setting.
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Affiliation(s)
| | - Ishan Hirji
- Bristol-Myers Squibb, Princeton, New Jersey, United States of America
| | | | | | - Joseph M. Connors
- BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, British Columbia, Canada
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Abstract
Intravenous brentuximab vedotin (ADCETRIS®) is a targeted antibody-drug conjugate (ADC) active against CD30-positive cancer cells such as those associated with classical Hodgkin lymphoma (HL). In noncomparative, phase 2 trials and in the real-world setting, salvage therapy with brentuximab vedotin resulted in high objective response (complete plus partial remission) rates in patients with relapsed or refractory CD30-positive HL, including as retreatment in patients who had an objective response to previous brentuximab vedotin therapy and subsequently relapsed. These beneficial outcomes were durable during long-term follow-up. As consolidation therapy after autologous haematopoietic stem cell transplant (ASCT) in the multinational, phase 3 AETHERA trial, brentuximab vedotin prolonged progression-free-survival (PFS) compared with placebo at a median follow-up of 30 months (primary analysis), with a 43% reduction in the risk of disease progression or death. The beneficial effects of brentuximab vedotin consolidation therapy were maintained during long-term follow-up. In the clinical trial and real-world setting, brentuximab vedotin had an acceptable tolerability and safety profile, with most adverse events manageable with dose reductions and/or delays [including peripheral sensory neuropathy (PSN) and neutropenia]. With a paucity of treatments available for many patients with relapsed or refractory HL, brentuximab vedotin represents an important option for the management of patients who have failed high-dose chemotherapy/ASCT or at least two prior chemotherapy regimens and as post-ASCT consolidation therapy in patients who are at increased risk/high-risk of relapse or progression after ASCT.
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Affiliation(s)
- Lesley J Scott
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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Tsai P, Thayer WO, Liu L, Silvestri G, Nordstrom JL, Garcia JV. CD19xCD3 DART protein mediates human B-cell depletion in vivo in humanized BLT mice. MOLECULAR THERAPY-ONCOLYTICS 2016; 3:15024. [PMID: 27119115 PMCID: PMC4824566 DOI: 10.1038/mto.2015.24] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 11/21/2022]
Abstract
Novel therapeutic strategies are needed for the treatment of hematologic malignancies; and bispecific antibody-derived molecules, such as dual-affinity re-targeting (DART) proteins, are being developed to redirect T cells to kill target cells expressing tumor or viral antigens. Here we present our findings of specific and systemic human B-cell depletion by a CD19xCD3 DART protein in humanized BLT mice. Administration of the CD19xCD3 DART protein resulted in a dramatic sustained depletion of human CD19+ B cells from the peripheral blood, as well as a dramatic systemic reduction of human CD19+ B-cell levels in all tissues (bone marrow, spleen, liver, lung) analyzed. When human CD8+ T cells were depleted from the mice, no significant B-cell depletion was observed in response to CD19xCD3 DART protein treatment, confirming that human CD8+ T cells are the primary effector cells in this in vivo model. These studies validate the use of BLT humanized mice for the in vivo evaluation and preclinical development of bispecific molecules that redirect human T cells to selectively deplete target cells.
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Affiliation(s)
- Perry Tsai
- Division of Infectious Diseases, Center for AIDS Research, University of North Carolina at Chapel Hill School of Medicine , Chapel Hill, North Carolina, USA
| | - William O Thayer
- Division of Infectious Diseases, Center for AIDS Research, University of North Carolina at Chapel Hill School of Medicine , Chapel Hill, North Carolina, USA
| | - Liqin Liu
- MacroGenics, Inc. , Rockville, Maryland, USA
| | - Guido Silvestri
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, Georgia, USA
| | | | - J Victor Garcia
- Division of Infectious Diseases, Center for AIDS Research, University of North Carolina at Chapel Hill School of Medicine , Chapel Hill, North Carolina, USA
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Cao Z, Wang Z, Sun J, Peng C, Feng S, Zhou X, Yang Q. [Effect of brentuximab vedotin combined with chlormethine hydrochloride on the treatment of 6 patients with relapsed and refractory Hodgkin lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2015; 36:575-7. [PMID: 26304081 PMCID: PMC7342637 DOI: 10.3760/cma.j.issn.0253-2727.2015.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To observe the clinical efficacy and side effects of brentuximab vedotin (BV) plus chlormethine hydrochloride (CH) in patients with relapsed and refractory Hodgkin lymphoma (HL) after failure with BV alone. METHODS From March, 2014 to December, 2014, 6 patients who failed with BV monotherapy were enrolled in this study. The chemotherapy regimen consisted of BV (1.2-1.8 mg/kg, iv. gtt, d1) and CH (6 mg/m2, iv. gtt, d1) was given for 3 weeks as one course, and all patients received about 3-8 courses of chemotherapy, with an median of 4 courses. Clinical efficacy and adverse events were assessed and observed by radiographic examination and serological detection. RESULTS Among 6 patients, the overall response rate was 100% with 2 complete remission and 4 partial remission. The main adverse events were grade I (2 patients) and IV (2 patients) bone marrow depression, grade II (2 patients)gastrointestinal reaction, grade I (1 patient) increase of transaminase and myocardial enzyme and grade I (1 patient) mouth ulcers. CONCLUSION The combination of BV and CH in the treatment of relapsed and refractory HL after failure with BV alone was high effective and the toxicities were well tolerable.
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Affiliation(s)
- Zhigang Cao
- The General Hospital of People's Liberation Armyl, Beijing 100853, China
| | - Zhihong Wang
- The General Hospital of People's Liberation Armyl, Beijing 100853, China
| | - Junzhong Sun
- The General Hospital of People's Liberation Armyl, Beijing 100853, China
| | - Chaojin Peng
- The General Hospital of People's Liberation Armyl, Beijing 100853, China
| | - Shaomei Feng
- The General Hospital of People's Liberation Armyl, Beijing 100853, China
| | - Xiaoyan Zhou
- The General Hospital of People's Liberation Armyl, Beijing 100853, China
| | - Qingming Yang
- The General Hospital of People's Liberation Armyl, Beijing 100853, China
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Grisold W, Grisold A, Marosi C, Meng S, Briani C. Neuropathies associated with lymphoma †. Neurooncol Pract 2015; 2:167-178. [PMID: 31386037 DOI: 10.1093/nop/npv025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Indexed: 12/12/2022] Open
Abstract
Neuropathy occurs with various manifestations as a consequence of lymphoma, and an understanding of the etiology is necessary for proper treatment. Advances in medical imaging have improved the detection of peripheral nerve involvement in lymphoma, yet tissue diagnosis is often equally important. The neoplastic involvement of the peripheral nervous system (PNS) in lymphoma can occur within the cerebrospinal fluid (CSF), inside the dura, or outside of the CSF space, affecting nerve root plexuses and peripheral nerves. The infiltration of either cranial or peripheral nerves in lymphoma is termed neurolymphomatosis (NL). These infiltrations can occur as mononeuropathy, multifocal neuropathy, symmetric neuropathies, or plexopathies. In rare cases, intravascular lymphoma (IL) can affect the PNS and an even rarer condition is the combination of NL and IL. Immune-mediated and paraneoplastic neuropathies are important considerations when treating patients with lymphoma. Demyelinating neuropathies, such as Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy, occur more frequently in non-Hodgkin's lymphoma than in Hodgkin's disease. Paraproteinemic neuropathies can be associated with lymphoma and paraneoplastic neuropathies are rare. While the treatment of lymphomas has improved, a knowledge of neurotoxic, radiotherapy, neoplastic, immune-mediated and paraneoplastic effects are important for patient care.
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Affiliation(s)
- Wolfgang Grisold
- Department of Neurology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (W.G.); Department of Neurology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (A.G.); Department of Oncology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (C.M.); Department of Radiology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (S.M.); Department of Neurosciences, University of Padova, Via Giustiniani, 5, Padova 35128, Italy (C.B.)
| | - Anna Grisold
- Department of Neurology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (W.G.); Department of Neurology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (A.G.); Department of Oncology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (C.M.); Department of Radiology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (S.M.); Department of Neurosciences, University of Padova, Via Giustiniani, 5, Padova 35128, Italy (C.B.)
| | - Christine Marosi
- Department of Neurology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (W.G.); Department of Neurology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (A.G.); Department of Oncology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (C.M.); Department of Radiology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (S.M.); Department of Neurosciences, University of Padova, Via Giustiniani, 5, Padova 35128, Italy (C.B.)
| | - Stefan Meng
- Department of Neurology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (W.G.); Department of Neurology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (A.G.); Department of Oncology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (C.M.); Department of Radiology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (S.M.); Department of Neurosciences, University of Padova, Via Giustiniani, 5, Padova 35128, Italy (C.B.)
| | - Chiara Briani
- Department of Neurology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (W.G.); Department of Neurology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (A.G.); Department of Oncology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (C.M.); Department of Radiology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (S.M.); Department of Neurosciences, University of Padova, Via Giustiniani, 5, Padova 35128, Italy (C.B.)
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Samir A, Elgamal BM, Gabr H, Sabaawy HE. Nanotechnology applications in hematological malignancies (Review). Oncol Rep 2015; 34:1097-105. [PMID: 26134389 PMCID: PMC4530900 DOI: 10.3892/or.2015.4100] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 02/16/2015] [Indexed: 02/06/2023] Open
Abstract
A major limitation to current cancer therapies is the development of therapy-related side-effects and dose limiting complications. Moreover, a better understanding of the biology of cancer cells and the mechanisms of resistance to therapy is rapidly developing. The translation of advanced knowledge and discoveries achieved at the molecular level must be supported by advanced diagnostic, therapeutic and delivery technologies to translate these discoveries into useful tools that are essential in achieving progress in the war against cancer. Nanotechnology can play an essential role in this aspect providing a transforming technology that can translate the basic and clinical findings into novel diagnostic, therapeutic and preventive tools useful in different types of cancer. Hematological malignancies represent a specific class of cancer, which attracts special attention in the applications of nanotechnology for cancer diagnosis and treatment. The aim of the present review is to elucidate the emerging applications of nanotechnology in cancer management and describe the potentials of nanotechnology in changing the key fundamental aspects of hematological malignancy diagnosis, treatment and follow-up.
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Affiliation(s)
- Ahmed Samir
- Department of Clinical Pathology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Basma M Elgamal
- Department of Clinical Pathology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hala Gabr
- Department of Clinical Pathology, Kasr Al‑Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hatem E Sabaawy
- Department of Clinical Pathology, Kasr Al‑Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
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Adverse events of monoclonal antibodies used for cancer therapy. BIOMED RESEARCH INTERNATIONAL 2015; 2015:428169. [PMID: 26075239 PMCID: PMC4436450 DOI: 10.1155/2015/428169] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 08/24/2014] [Indexed: 01/12/2023]
Abstract
In 1997, the first monoclonal antibody (MoAb), the chimeric anti-CD20 molecule rituximab, was approved by the US Food and Drug administration for use in cancer patients. Since then, the panel of MoAbs that are approved by international regulatory agencies for the treatment of hematopoietic and solid malignancies has continued to expand, currently encompassing a stunning amount of 20 distinct molecules for 11 targets. We provide a brief scientific background on the use of MoAbs in cancer therapy, review all types of monoclonal antibodies-related adverse events (e.g., allergy, immune-related adverse events, cardiovascular adverse events, and pulmonary adverse events), and discuss the mechanism and treatment of adverse events.
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Afable M, Caimi PF, Hosing C, de Lima M, Khouri I, William BM, Nieto Y, Cooper BW, Anderlini P, Gerson SL, Lazarus HM, Champlin R, Popat U. Hematopoietic Progenitor Cell Harvesting Is Feasible after Treatment with Brentuximab Vedotin in CD30(+) Lymphoma Patients Who Received Multiple Prior Lines of Treatment. Biol Blood Marrow Transplant 2015; 21:1529-1531. [PMID: 25937397 DOI: 10.1016/j.bbmt.2015.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/22/2015] [Indexed: 01/16/2023]
Abstract
Brentuximab vedotin (BV), an antibody-drug conjugate that targets CD30, induces high response rates in CD30(+) lymphoid malignancies. It is unknown if BV use affects procurement of autologous CD34(+) stem cells and hematopoietic engraftment after autologous stem cell transplantation (ASCT). We examined 42 patients treated with BV before mobilization. Median times from diagnosis to transplantation, from initial BV treatment to transplantation, and from last BV treatment to stem cell collection were 21 months (range, 10 to 210), 5 months (range, 1.5 to 16.8), and 30 days (range, 2 to 280), respectively. Mobilization was successful on the first attempt in 38 patients (90.4%). The median number of infused CD34(+) cells was 5.46 × 10(6)/kg (range, 1.65 to 54.78 × 10(6)/kg). The median times to neutrophil and platelet engraftment were 10 (range, 9 to 13), and 10.5 days (range, 7 to 35), respectively. BV before high-dose chemotherapy-ASCT did not adversely affect peripheral blood stem cell mobilization and subsequent engraftment in a cohort of heavily pretreated patients with CD30(+) lymphomas.
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Affiliation(s)
- Manuel Afable
- University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | - Paolo F Caimi
- University Hospitals Seidman Cancer Center, Cleveland, Ohio.,Division of Hematology and Oncology, Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - Chitra Hosing
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marcos de Lima
- University Hospitals Seidman Cancer Center, Cleveland, Ohio.,Division of Hematology and Oncology, Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - Issa Khouri
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Basem M William
- University Hospitals Seidman Cancer Center, Cleveland, Ohio.,Division of Hematology and Oncology, Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - Yago Nieto
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brenda W Cooper
- University Hospitals Seidman Cancer Center, Cleveland, Ohio.,Division of Hematology and Oncology, Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - Paolo Anderlini
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stanton L Gerson
- University Hospitals Seidman Cancer Center, Cleveland, Ohio.,Division of Hematology and Oncology, Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - Hillard M Lazarus
- University Hospitals Seidman Cancer Center, Cleveland, Ohio.,Division of Hematology and Oncology, Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - Richard Champlin
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Uday Popat
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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Abstract
To date, over 100 noncanonical amino acids (ncAAs) have been genetically encoded in living cells in order to expand the functional repertoire of the canonical 20 amino acids. More recently, this technology has been expanded to the field of protein therapeutics, where traditional chemical methods typically result in heterogeneous mixtures of proteins. The site-specific incorporation of ncAAs with orthogonal chemical groups allows unprecedented control over the site of conjugation and the stoichiometry, thus facilitating the rational optimization of the biological functions and/or pharmacokinetics of biologics. Herein, we discuss the recent contribution of ncAA technology in enhancing the pharmacological properties of current protein therapeutics as well as developing novel therapeutic modalities.
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Affiliation(s)
- Sophie B. Sun
- Dr. S.B. Sun, Prof. P.G. Schultz, Dr. C.H. Kim, California Institute for Biomedical Research, 11119 North Torrey Pines Road, Suite 100, La Jolla, California 92037
| | - Peter G. Schultz
- Dr. S.B. Sun, Prof. P.G. Schultz, Dr. C.H. Kim, California Institute for Biomedical Research, 11119 North Torrey Pines Road, Suite 100, La Jolla, California 92037
- Prof. P.G. Schultz, Department of Chemistry, The Scripps Research Institute, 10550 North Torrey Pines Road, SR202, La Jolla, California 92037
| | - Chan Hyuk Kim
- Dr. S.B. Sun, Prof. P.G. Schultz, Dr. C.H. Kim, California Institute for Biomedical Research, 11119 North Torrey Pines Road, Suite 100, La Jolla, California 92037
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