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      Severe Acute Pulmonary Toxicity Associated with Brentuximab in a Patient with Refractory Hodgkin's Lymphoma

      case-report

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          Abstract

          Acute pulmonary toxicity associated with brentuximab appears to be a rare but serious adverse effect that can be potentially fatal. We report the case of a twenty-nine-year-old female with Hodgkin's lymphoma who was treated with brentuximab and later presented with severe acute pulmonary toxicity; she improved after the discontinuation of brentuximab and administration of antibiotics and glucocorticoid therapy. Currently there is very little data in the literature in regard to the clinical manifestations and characteristics of patients taking brentuximab and the potential development of acute severe pulmonary toxicity, as well as the appropriate therapeutic approach, making this particular case of successful treatment and resolution unique.

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          Intracellular activation of SGN-35, a potent anti-CD30 antibody-drug conjugate.

          M Alley, Xinqun Zhang, Maurice L. Sievers … (2010)
          SGN-35 is an antibody-drug conjugate (ADC) containing the potent antimitotic drug, monomethylauristatin E (MMAE), linked to the anti-CD30 monoclonal antibody, cAC10. As previously shown, SGN-35 treatment regresses and cures established Hodgkin lymphoma and anaplastic large cell lymphoma xenografts. Recently, the ADC has been shown to possess pronounced activity in clinical trials. Here, we investigate the molecular basis for the activities of SGN-35 by determining the extent of targeted intracellular drug release and retention, and bystander activities. SGN-35 was prepared with (14)C-labeled MMAE. Intracellular ADC activation on CD30(+) and negative cell lines was determined using a combination of radiometric and liquid chromatograhpy/mass spectrometry-based assays. The bystander activity of SGN-35 was determined using mixed tumor cell cultures consisting of CD30(+) and CD30(-) lines. SGN-35 treatment of CD30(+) cells leads to efficient intracellular release of chemically unmodified MMAE, with intracellular concentrations of MMAE in the range of 500 nmol/L. This was due to specific ADC binding, uptake, MMAE retention, and receptor recycling or resynthesis. MMAE accounts for the total detectable released drug from CD30(+) cells, and has a half-life of retention of 15 to 20 h. Cytotoxicity studies with mixtures of CD30(+) and CD30(-) cell lines indicated that diffusible released MMAE from CD30(+) cells was able to kill cocultivated CD30(-) cells. MMAE is efficiently released from SGN-35 within CD30(+) cancer cells and, due to its membrane permeability, is able to exert cytotoxic activity on bystander cells. This provides mechanistic insight into the pronounced preclinical and clinical antitumor activities observed with SGN-35.
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            Brentuximab vedotin: a CD30-directed antibody-cytotoxic drug conjugate.

            Stephen Newland, Q. Li, Nancy Lowe … (2012)
            Hodgkin lymphoma (HL) and systemic anaplastic large cell lymphoma (sALCL), which is a subtype of non-Hodgkin lymphoma, are relatively uncommon lymphoproliferative types of cancer. These malignancies are highly curable with initial treatment. Nonetheless, some patients are refractory to or relapse after first- and second-line therapies, and outcomes for these patients are less promising. Brentuximab vedotin is a CD30-directed antibody-cytotoxic drug conjugate that has demonstrated efficacy in response rates (objective response rates and complete response) when given to patients with refractory or relapsed HL and sALCL. Although not compared directly in clinical trials, the response rates with brentuximab vedotin are higher than those of several current treatments for refractory or relapsed HL and sALCL. Adverse effects associated with brentuximab vedotin are considered manageable. Nonetheless, several serious adverse effects (e.g., neutropenia, peripheral sensory neuropathy, tumor lysis syndrome, Stevens-Johnson syndrome, and progressive multifocal leukoencephalopathy, resulting in death) have been reported with its use. Despite a lack of survival and patient reported outcome data, the United States Food and Drug Administration (FDA) granted accelerated approval to brentuximab vedotin for the treatment of HL after failure of autologous stem cell transplantation or at least two combination chemotherapy regimens, and for sALCL after failure of at least one combination chemotherapy regimen. With this approval, brentuximab vedotin is the first FDA-approved agent for the treatment of HL in over three decades and the first agent specifically indicated to treat sALCL. Results of ongoing prospective trials should determine if brentuximab vedotin has a survival benefit when compared directly with standard treatment and if brentuximab vedotin is safe and efficacious when given earlier in the disease process, or when used with other chemotherapy for the treatment of HL and sALCL or other CD30-positive malignancies. © 2012 Pharmacotherapy Publications, Inc.
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              Delayed onset bleomycin-induced pneumonitis.

              M Yaman, F Oz, C Akman … (2005)
              We describe a 39-year-old male patient who developed bleomycin-induced pneumonitis 2 years after completion of chemotherapy for nonseminomatous testicular cancer. Bleomycin sometimes causes fatal pulmonary toxicity, including bleomycin-induced pneumonitis. The central event in the development of pneumonitis is endothelial damage of the lung vasculature due to bleomycin-induced cytokines and free radicals. Pulmonary toxicity usually begins at bleomycin administration. The development of bleomycin-induced pneumonitis up to 6 months after bleomycin therapy has also been reported. We report a patient who developed bleomycin-induced pneumonitis 2 years after the initiation of bleomycin-containing chemotherapy regimens.
              Article 0 comments Cited 9 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Case Rep Pulmonol
                Journal ID (iso-abbrev): Case Rep Pulmonol
                Journal ID (publisher-id): CRIPU
                Title: Case Reports in Pulmonology
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 2090-6846
                ISSN (Electronic): 2090-6854
                Publication date (Print): 2016
                Publication date (Electronic): 17 April 2016
                Volume: 2016
                Electronic Location Identifier: 2359437
                Affiliations
                1Division of General Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA
                2Division of Medical Education, Paul L. Foster School of Medicine and Texas Tech University HSC, El Paso, TX 79905, USA
                3School of Medicine, Universidad Autonoma de Tamaulipas (UAT), Tampico, Mexico
                4Division of Hematology and Oncology, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA
                5Division of Pulmonary and Critical Care Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA
                Author notes
                *Mateo Porres-Aguilar: mateo.porres@ 123456ttuhsc.edu

                Academic Editor: Tun-Chieh Chen

                Article
                DOI: 10.1155/2016/2359437
                PMC ID: 4852124
                PubMed ID: 27190667
                SO-VID: b9a27d6a-3812-4039-9de0-45e926c0b013
                Copyright © Copyright © 2016 Yasmin Sabet et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 7 January 2016
                Date accepted : 31 March 2016
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Respiratory medicine
                Data availability:
                ScienceOpen disciplines: Respiratory medicine

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