Seattle Genetics today summarized Adcetris®(brentuximab vedotin) data in Hodgkin lymphoma (HL) and non-Hodgkin lymphoma from multiple presentations at the 55th American Society of Hematology (ASH) Annual Meeting and Exposition taking place in New Orleans, Louisiana, December 7-10, 2013. Highlights include encouraging interim data from a phase 2 clinical trial evaluating Adcetris as a single-agent for previously untreated HL patients age 60 or older and updated data from a phase 1 clinical trial of Adcetris in combination with chemotherapy for the treatment of newly diagnosed mature T-cell lymphoma (MTCL) patients, commonly referred to as peripheral T-cell lymphoma (PTCL). In addition, data were presented from an investigator-sponsored phase 2 clinical trial evaluating Adcetris in relapsed cutaneous T-cell lymphoma (CTCL). Adcetris is an antibody-drug conjugate (ADC) directed to CD30. Adcetris is currently not approved for the treatment of frontline HL, frontline MTCL or relapsed CTCL.
“Adcetris is being evaluated broadly through more than 20 ongoing corporate and investigator-sponsored clinical trials in a variety of Hodgkin lymphoma and non-Hodgkin lymphoma disease settings,” said Jonathan Drachman, M.D., Chief Medical Officer and Executive Vice President, Research and Development at Seattle Genetics. “The interim data evaluating Adcetris as a treatment for older Hodgkin lymphoma patients are particularly encouraging, suggesting compelling activity and a manageable safety profile in a patient population that historically cannot tolerate conventional combination chemotherapy regimens and has inferior outcomes. In addition, updated data from trials evaluating Adcetris in both frontline mature T-cell lymphoma and cutaneous T-cell lymphoma provide strong rationale for the ongoing phase 3 ECHELON-2 and ALCANZA clinical trials.”
Frontline Data Presentations
A Phase 2 Study of Single-Agent Brentuximab Vedotin for Frontline Therapy of Hodgkin Lymphoma in Patients Age 60 Years and Above: Interim Results (Abstract #4389)
Data were presented from an ongoing phase 2 clinical trial evaluating ADCETRIS as frontline therapy for patients age 60 or older with previously untreated HL. The data presented are from a trial that is designed to assess the activity and tolerability of Adcetris as a monotherapy for older HL patients who have received no prior treatment. Interim data were reported from 19 patients. The median age of patients was 78 years (range, 64 to 92). The data were highlighted in a poster presentation by Dr. Christopher Yasenchak from the Northwest Cancer Specialists in Tualatin, OR. The key findings included:
- Of the 19 patients evaluable at the time of this analysis, 17 patients (89 percent) had an objective response, including 12 (63 percent) complete remissions and five (26 percent) partial remissions.
- All 19 patients (100 percent) achieved tumor reduction as determined by best percentage change from baseline.
- The median duration of treatment was 18 weeks (six cycles) at the time of analysis.
- The most common treatment-emergent adverse events were Grade 1 or 2 and included peripheral sensory neuropathy (47 percent), fatigue (32 percent), diarrhea (26 percent), peripheral edema (26 percent), itching (26 percent), hair loss (21 percent), nausea (21 percent) and urinary tract infection (21 percent).
- Grade 3 events occurring in one patient each included peripheral sensory neuropathy, rash, neutropenia and dizziness upon standing. No Grade 4 events were observed.
Brentuximab Vedotin Administered Before, During, and After Multi-agent Chemotherapy in Patients with Newly-diagnosed CD30+ Mature T- and NK-cell Lymphomas (Abstract #4386)
Data were presented from a phase 1 clinical trial evaluating Adcetris administered in combination with or sequentially with chemotherapy for the treatment of newly-diagnosed MTCL. Data were reported in 13 patients who received sequential treatment with two cycles of Adcetris followed by six cycles of the combination chemotherapy regimen CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) and 26 patients who received the combination regimen of Adverts plus CHP (A+CHP), which removes vincristine (Oncovin). The median age of patients was 57 years. The data were highlighted in a poster presentation by Dr. Michelle Fanale from The University of Texas MD Anderson Cancer Center.
Updated key findings for Adcetris in combination with CHP included:
- Of 26 patients receiving the combination regimen, 23 (88 percent) received all six cycles of initial treatment with A+CHP. Twenty-one patients received maintenance treatment with single-agent Adcetris for up to ten additional cycles.
- All 26 patients (100 percent) achieved an objective response following combination therapy, including 23 (88 percent) complete remissions and three (12 percent) partial remissions.
- All patients in complete remission after combination therapy maintained response during maintenance. One patient with partial remission during combination treatment converted to complete remission during maintenance.
- The median observation time from first dose of therapy was 21.4 months. The estimated one-year progression-free survival rate was 71 percent and one-year overall survival rate was 88 percent.
- The most common treatment-emergent adverse events of any grade occurring in more than 40 percent of patients were peripheral sensory neuropathy (69 percent), nausea (65 percent), diarrhea (58 percent), fatigue (58 percent), shortness of breath (46 percent) and constipation (38 percent).
- The most common Grade 3 treatment-emergent adverse events were febrile neutropenia, anemia and peripheral sensory neuropathy.
Based on these results, a global phase 3 study called ECHELON-2 was initiated and is currently enrolling patients. The ECHELON-2 trial is a randomized, double-blind, placebo-controlled, multi-center trial designed to investigate A+CHP versus CHOP as frontline therapy in patients with CD30-expressing MTCL, also known as peripheral T-cell lymphoma. Approximately 300 patients (approximately 150 patients per treatment arm) will be randomized to receive A+CHP or CHOP for six to eight cycles every three weeks.
Investigator-Sponsored Data Presentation
Phase II Trial of Brentuximab Vedotin (SGN-35) for CD30+ Cutaneous T-Cell Lymphomas and Lymphoproliferative Disorders (Abstract #367)
Data were presented from a phase 2 investigator-sponsored trial evaluating the use of ADCETRIS in CD30-positive CTCL patients, including lymphomatoid papulosis (LyP), primary cutaneous anaplastic large cell lymphoma (pcALCL) or mycosis fungoides (MF). The ongoing study is being conducted by Dr. Madeleine Duvic from The University of Texas MD Anderson Cancer Center in Houston, TX. The primary endpoints of the trial are to evaluate the safety and activity of ADCETRIS in CD30-positive CTCL. Among 56 patients enrolled to date, 48 patients had received at least two doses of ADCETRIS and were evaluable at the time of analysis. The key findings included:
- Thirty-five of 48 patients (73 percent) achieved an objective response, including 20 of 20 (100 percent) with LyP and/or pcALCL and 15 of 28 (54 percent) with MF.
- In patients with MF, the median time to response was 12 weeks and the median duration of response was 32 weeks. In patients with LyP and/or pcALCL, the median time to response was three weeks and the median duration of response was 26 weeks.
- Responses were observed in patients with CD30 expression levels ranging from less than 10 percent to more than 50 percent based on standard screening methods.
- The most common adverse events were peripheral neuropathy (65 percent), fatigue (41 percent) and rash (27 percent). Other common adverse events included nausea, neutropenia, myalgia, diarrhea and localized skin infection.
- The most common Grade 3 adverse events were neutropenia (five three patients), nausea (two patients), chest pain (two patients), arthralgia (two patients) and infection (two patients). Other Grade 3 or 4 events occurring in one patient each included fatigue, deep vein thrombosis, elevated liver function tests and dehydration. Two patient deaths occurred due to untreated sepsis, including one elderly patient with ALCL after one dose and one patient due to a urinary tract infection.
Seattle Genetics and Millennium: The Takeda Oncology Company are conducting the ALCANZA trial, a randomized phase 3 clinical trial of Adcetris for relapsed CD30-positive CTCL patients. The trial is assessing Adcetris versus investigator’s choice of methotrexate or bexarotene in patients with CD30-positive CTCL, including those with pcALCL or MF. The primary endpoint of the study is overall response rate lasting at least four months. Approximately 124 patients will be enrolled in the pivotal trial.