Antibody drug conjugate (ADC) therapy are a type of monoclonal antibody.
What is antibody drug conjugate (ADC) therapy?
When chemotherapy is usually administered, it is injected into the bloodstream and kills all rapidly dividing cells, the good and the bad. An antibody is a blood protein that is produced in response to a specific antigen (toxin or infection). Antibody drug conjugate therapies are made up of an antibody that is joined to a chemotherapy medicine. The antibody drug conjugate (ADC) therapy targets and attaches to lymphoma cells. The chemotherapy is joined to the antibody so that it allows the chemotherapy to be delivered directly to the lymphoma cell. The lymphoma cells can therefore die without the widespread side effects of chemotherapy.
Brentuximab vedotin (AdcetrisTM)
The first type of ADC developed was brentuximab vedotin which is a targeted medicine being used in certain types of lymphoma by targeting the CD30 protein found on the surface of the lymphoma cells. Brentuximab vedotin is a targeted treatment that consists of an antibody joined to a chemotherapy drug that is like vincristine.
The antibody binds (sticks) to lymphoma cells that have a specific protein, delivering the chemotherapy directly to the lymphoma cells. The chemotherapy drugs used in this type of treatment are good at killing lymphoma cells but cannot be given into the bloodstream on their own because they are too toxic. It works by targeting a marker on the cell, which is referred to as CD30, that is a marker found on certain lymphoma subtypes.
Brentuximab vedotin is given every three weeks either alone or in combination with chemotherapy depending on your subtype and disease status of lymphoma.
Indications of use
In Australia, brentuximab vedotin is publicly funded on the PBS for the following indications:
- Relapsed or refractory CD30+ Hodgkin lymphoma either following autologous stem cell transplant (ASCT) OR following at least two prior therapies when ASCT or multi-agent chemotherapy is not a treatment option.
- Patients with CD30+ Hodgkin lymphoma at higher risk of relapse or progression following ASCT.
- Relapsed or refractory CD30+ anaplastic large cell lymphoma in patients who have undergone appropriate prior front-line curative chemotherapy.
- Relapsed or refractory CD30+ cutaneous T cell lymphoma (including mycosis fungoides, Sezary syndrome or primary cutaneous anaplastic large cell lymphoma).
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There are several clinical trials in Australia and around the world that are currently investigating the use of brentuximab vedotin.
Method of administration
Brentuximab vedotin is given by intravenous infusion which means it goes directly into the vein through a needle in the arm or through a central line.
The recommended dose of brentuximab vedotin is infused over 30 minutes. It must not be administered as an intravenous push or bolus. It should be administered through a dedicated intravenous line and it must not be mixed with other medicinal products.
Common side effects
There are several common side effects of brentuximab vedotin. Many of these side effects are common to the chemotherapy drug called vincristine (a similar chemotherapy drug that is used in the ADC). Some of the common side effects can include:
- Nausea
- Peripheral neuropathy (numbness and tingling of the hands and feet)
- Tiredness
- Neutropenia (low white cell count)
- Thrombocytopenia (low platelets)
- Respiratory tract infection
- Hyperglycaemia (high blood sugar)
- Diarrhoea
- Skin rash
- Arthralgia and myalgia
Polatuzumab vedotin (PolivyTM)
Polatuzumab vedotin (PolivyTM) is an antibody-drug conjugate. This is an antibody that is joined to a chemotherapy (like vincristine), which allows the chemotherapy to be delivered directly to the cancer cells. Polatuzumab vedotin targets a cell surface component of the B-cell receptor called CD79b
Indications of use
In Australia, as of August 2020, Polatuzumab vedotin has been TGA approved (safe to use in Australia), however is not currently PBS funded. Polatuzumab vedotin is indicated to be used in combination with Bendamustine (chemotherapy) and rituximab (monoclonal antibody).
- Polatuzumab vedotin is indicated for the treatment of previously treated adult patients with diffuse large B-cell lymphoma who are not candidates for hematopoietic stem cell transplant.
Method of administration
- Polatuzumab vedotin is given intravenously (through a drip)
- A dedicated line is needed
- A filter is needed
Six cycles. - Cycles are given every 21 days
- Cycle 1. Dose is given on day 2 over 90 minutes.
- Cycle 2-6. Dose is given on day 1 over 30 minutes if prior infusion well tolerated in cycle 1
Common side effects
- Fever
- Tiredness
- Nerve problems
- Diarrhoea
- Loss of appetite
- Body aches or pain
- Joint pain
- Weight loss
- Headache
