Home Drug Guide Brentuximab Vedotin

Drug Guide

Generic Name

Brentuximab Vedotin

Brand Names Adcetris

Classification

Therapeutic: Antineoplastic Agent

Pharmacological: Antibody-Drug Conjugate

FDA Approved Indications

Hodgkin lymphoma (relapsed or refractory)
Systemic anaplastic large cell lymphoma (relapsed or refractory)

Mechanism of Action

Brentuximab vedotin is an antibody-drug conjugate that targets CD30-positive cells. The conjugate binds to CD30, is internalized, and subsequently releases monomethyl auristatin E (MMAE), which inhibits microtubule formation, leading to cell cycle arrest and apoptosis.

Dosage and Administration

Adult: 3.6 mg/kg IV infusion over 30 minutes every 3 weeks, up to 16 cycles

Pediatric: Safety and effectiveness not established in pediatric patients

Geriatric: Use with caution; no specific dosage adjustment recommended but consider age-related comorbidities

Renal Impairment: Use with caution; no specific dose adjustment recommended, monitor renal function

Hepatic Impairment: Use with caution; no specific dose adjustment recommended, monitor hepatic function

Pharmacokinetics

Absorption: Administered intravenously; bioavailability not applicable

Distribution: Wide distribution, including to tissues and lymph nodes

Metabolism: Metabolized primarily in the liver to active and inactive metabolites

Excretion: Eliminated via feces and urine

Half Life: Approximately 4 to 6 days

Contraindications

Hypersensitivity to brentuximab vedotin or its components

Precautions

Progressive multifocal leukoencephalopathy (PML), monitor neurological status
Peripheral neuropathy, avoid use if severe
Infusion reactions, administer with monitoring
Bacterial, viral, and fungal infections, monitor and manage appropriately

Adverse Reactions - Common

Fatigue (Common)
Nausea (Common)
Fever (Common)
Neutropenia (Common)
Peripheral sensory neuropathy (Common)

Adverse Reactions - Serious

PML (Progressive multifocal leukoencephalopathy) (Rare)
Serious infections (sepsis, pneumonia) (Less common)
Perforation or fistula (Uncommon)
Stevens-Johnson syndrome/toxic epidermal necrolysis (Rare)

Drug-Drug Interactions

Bone marrow suppressants, increase risk of severe cytopenias

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for infusion reactions, peripheral neuropathy, signs of infections, complete blood counts regularly

Diagnoses:

Risk for infection
Risk for peripheral neurotoxicity
Risk for bleeding or thrombocytopenia

Implementation: Pre-medicate with antihistamines or steroids if indicated, monitor patient during and post-infusion, handle with care due to cytotoxicity

Evaluation: Assess for adverse reactions, effectiveness in tumor reduction, monitor blood counts

Patient/Family Teaching

Inform about signs of infection, peripheral neuropathy, or infusion reactions
Advise on avoiding live vaccines during treatment
Report any unexplained fever, nerve changes, or severe reactions immediately

Special Considerations

Black Box Warnings:

Progressive multifocal leukoencephalopathy (PML)

Genetic Factors: N/A

Lab Test Interference: May cause false elevations in serum transaminases and bilirubin due to hepatic metabolism

Overdose Management

Signs/Symptoms: Severe cytopenias, neurotoxicity, infusion reactions

Treatment: Supportive care, interruption or discontinuation of therapy, symptomatic management, no specific antidote

Storage and Handling

Storage: Store refrigerated at 2°C to 8°C (36°F to 46°F); do not freeze

Stability: Stable for 24 hours at room temperature after reconstitution, discard unused portions