Brentuximab vedotin

Abstract

Peripheral neuropathy and neurotoxicity: 4 case reports In a case series, four patients (two men and two women), aged 64–68 years were described, who developed peripheral neuropathy (three patients) and neurotoxicity (one patient) during treatment with brentuximab vedotin for advanced TCell lymphoma (ATCL) [dosages, routes, times to reactions onsets and outcomes not stated; not all immediate causes deaths stated]. Patient 1: A 64-year-old woman, who had erythrodermic cutaneous T-cell lymphoma (initially T4N0M0B1), gradually developed Sezary Syndrome (T4N0M0B2). She received doxorubicin and gemcitabine, and was scheduled for an allogenic transplantation. In the meantime, she was treated with six cycles of brentuximab vedotin. However, due to brentuximab vedotin, she developed grade II peripheral neuropathy. The woman’s therapy with brentuximab vedotin was switched to bexarotene. However, she died after 26 months of lymphoma diagnosis. Patient 2: A 68-years-old man with stage IB folliculotropic mycosis fungoides (FMF) T2bN0M0B0, large cell transformation and CD30+ 30% in skin histology, had many episodes of skin relapses. He received five cycles of therapy with brentuximab vedotin. Thereafter, he developed grade IV neuropathy due to brentuximab vedotin. The man’s therapy with brentuximab vedotin was withdrawn. He remained non ambulatory for 5 months after discontinuation, and died 4 years after lymphoma diagnosis due to upper respiratory metastasis. Patient 3: A 65-year-old man had stage IB FMF (T2bN0M0B0). His condition progressed to stage IIB FMF (T3N0M0B01). He was then treated with antineoplastics and radiotherapy. His skin condition relapsed with large cell transformation and high Ki67 index. Thereafter, he started receiving brentuximab vedotin. After six cycles of therapy, he developed grade II neurotoxicity. The man’s therapy with brentuximab vedotin was continued. Despite another six cycles of brentuximab vedotin, his condition relapsed and finally progressed with aggressively appearing tumours. No response to unspecified multichemotherapy were obtained. After 15 months of brentuximab vedotin initiation, he died. Patient 4: A 66-year-old woman, who had stage IB fMF (Τ2bΝ0Μ0Β0), progressed to T3N0M0B0 18 months after her first diagnosis. She received topical electron beam therapy. However, her skin condition relapsed. Subsequently, she started receiving brentuximab vedotin. Following four cycles of therapy, she developed grade II peripheral neuropathy. The woman’s therapy with brentuximab vedotin was continued, and was scheduled for 8 cycles in total. Her brentuximab vedotin dose was regulated at 1.2 mg/kg after the development of neuropathy. Author comment: The commonest side effect [due to brentuximab-vedotin], peripheral neuropathy developed between cycles 4–6 . After six cycles [of brentuximabvedotin] he developed grade II neurotoxicity.