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NICE recommend brentuximab vedotin (Adcetris▼) for the treatment of CD30-positive cutaneous T-cell lymphoma

Adcetris▼, for Non-Hodgkin lymphoma and Primary cutaneous T-cell lymphoma from Takeda

The National Institute for Health and Care Excellence (NICE) has approved Takeda's CD30-positive cutaneous T-cell lymphoma treatment brentuximab vedotin, brand name Adcetris▼ for use by the NHS in England and Wales.

The full recommendation states that:

Brentuximab vedotin (Adcetris) is available on the NHS. It is a possible treatment for CD30-positive cutaneous T-cell lymphoma in adults if:
  • they have already had 1 systemic therapy
  • they have mycosis fungoides stage IIB or over, primary cutaneous anaplastic large cell lymphoma or Sézary syndrome.
If you are not eligible for brentuximab vedotin but are already taking it, you should be able to continue until you and your doctor decide when best to stop.

There are more than 50 different diseases that involve B cells or T cells (lymphocytes), which are types of white blood cell. Each of these lymphomas has a distinct appearance under the microscope, a different cell pattern, and a different pattern of symptoms and progression. Most non-Hodgkin lymphomas (85%) are from B cells. Less than 15% develop from T cells.

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Why the committee made these recommendations
Brentuximab vedotin is licensed to treat CD30-positive CTCL after at least 1 systemic therapy. It is most likely to be used in the NHS as an alternative to systemic treatments to treat advanced disease. At this point in the pathway, current treatment options include methotrexate, bexarotene and interferon alfa.

Clinical trial evidence shows that brentuximab vedotin is better than methotrexate or bexarotene in terms of response rates and extending how long people live without their disease getting worse. For some people with CTCL, brentuximab vedotin will be used as a bridge to a stem cell transplant.

About Adcetris (source EMA)
Adcetris is a cancer medicine used to treat adults with Hodgkin’s lymphoma (HL, a type of cancer that originates from blood cells in the lymphatic system, a part of the immune system). Adcetris is used when the tumour cells are CD30-positive (when they have a protein called CD30 on their surface) and is given:
  • together with doxorubicin, vinblastine and dacarbazine (other cancer medicines) in HL patients who have stage IV disease (advanced cancer that has spread to other parts of the body) that has not been treated before;
  • when the cancer has come back or has not responded to an autologous stem cell transplant (a transplant of the patient's own blood-producing cells);
  • when patients have had an autologous stem cell transplant but are considered to be at increased risk of the cancer coming back or not responding;
  • when the cancer has come back or has not responded to at least two other therapies and when autologous stem cell transplant or multi-agent chemotherapy (a combination of cancer medicines) cannot be used.
Adcetris is also used to treat adults with two other lymphomas:
  • systemic anaplastic large cell lymphoma (sALCL, a CD30-positive cancer of white blood cells called T lymphocytes), when the cancer has come back or has not responded to other treatments;
  • CD30-positive cutaneous T-cell lymphoma (CTCL), a lymphoma of T lymphocytes (a form of non-Hodgkins lymphoma) that initially affects the skin, in patients who have received at least one previous treatment.
These diseases are rare, and Adcetris was designated an ‘orphan medicine’ (a medicine used in rare diseases) on various dates. Further information on the orphan designations can be found on the European Medicines Agency’s website (Hodgkin’s lymphoma: 15 January 2009; Anaplastic large cell lymphoma: 15 January 2009; Cutaneous T-cell lymphoma: 11 January 2012).

The active substance in Adcetris, brentuximab vedotin, is made up of a CD30 monoclonal antibody (a type of protein that attaches to CD30). The monoclonal antibody is attached to monomethyl auristatin E, a cytotoxic (cell-killing) molecule. The monoclonal antibody delivers monomethyl auristatin E to the CD30-positive cancer cells, and once inside the cancer cells, it stops them from dividing, and the cancer cells eventually die.

Adcetris was first made available in the EU in 2012. It is manufactured by Takeda.

Sources
European Medicines Agency website page for Adcetris
NHS website for non-Hodgkins lymphoma
Contains public sector information licensed under the Open Government Licence v3.0.
Accessed 25/04/19
Links available in full article

© NICE [2019] Brentuximab vedotin for treating CD30-positive cutaneous T-cell lymphoma [TA577] Available from: See Link below. All rights reserved. Subject to Notice of rights
NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.

The information provided by NICE was accurate at the time this article was issued.


Link to NICE information on Adcetris in the treatment of CD30-positive cutaneous T-cell lymphoma

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