What to Know About Adcetris (Brentuximab Vedotin)

An Antibody-Drug Conjugate Approved to Treat Several Forms of Lymphoma

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Adcetris (brentuximab vedotin) is a medication used in the treatment of aggressive forms of lymphoma—cancers of the body’s lymphatic system, which is part of the body's immune system. Given intravenously (IV), this medication may sometimes be used with chemotherapy or on its own.

This medication is a synthetically produced antibody that’s been modified to target and kill cancerous cells that express the protein CD30.

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Uses

Adcetris is often prescribed after other initial therapies have already been attempted. Specifically, it’s approved for:

  • Stage III or IV classical Hodgkin lymphoma (cHL): cHL is the most common form of lymphoma. In the majority of cases, cHL originates from B-cells, which help protect the body from infections by forming antibodies. Adcetris is prescribed when this cancer is diagnosed In an advanced stage.
  • cHL after autologous hematopoietic cell transplantation (HCT): HCT therapy involves the transfusion of stem cells (immature cells that can develop into many different forms) to re-establish bone marrow and immune function. If there is a risk of relapse of cancer or if this treatment was not successful, Adcetris may be prescribed. 
  • cHL after other therapy: If other approaches, such as radiation or chemotherapy, have not been successful in treating cHL, or if there is a relapse, Adcetris is indicated for use.
  • Systemic anaplastic large cell lymphoma (sALCL): sALCL is a rare, aggressive form of non-Hodgkin lymphoma that usually develops from T-cells (a type of immune cell). Adcetris may be prescribed alongside cyclophosphamide, Lipodox (doxorubicin), and Rayos (prednisone) as part of the initial chemotherapy regimen. It may also be considered after other therapies have not yielded good results.  
  • Primary cutaneous anaplastic large cell lymphoma (pcALCL)/CD30-expressing mycosis fungoides (MF): pcALCL primarily appears in the skin and is considered less aggressive than the blood form of cHL. MF is another rare form of lymphoma that targets the body’s T-cells. In both cases, Adcetris is recommended only if prior treatments have not yielded results.    

Before Taking

Diagnosis and assessment of cancer are necessary before Adcetris can be prescribed. Lymphoma is diagnosed by a physical assessment, blood tests, and biopsy of the lymph node (in which a small portion is extracted for evaluation).

The subtype and progression of the disease can be evaluated using any number of methods:

  • X-ray
  • Bone marrow biopsy
  • Lumbar puncture
  • Computer tomography (CT scan)
  • Positron emission tomography (PET scan)
  • Bone scan
  • Magnetic resonance imaging (MRI)

Precautions and Contraindications

Adcetris and drugs like it can have a range of effects on the body, and some people may not be good candidates for this therapy. Factors that need to be considered include:

  • Bleo 15k (bleomycin) therapy: This drug cannot be given to patients also receiving bleomycin therapy due to its potentially harmful effects on the lungs.
  • Presence of peripheral neuropathy: Peripheral neuropathy occurs when the nerves In the body become damaged. Adcetris can worsen or cause neuropathy.
  • Severe allergic reaction: Anaphylaxis, a severe allergic reaction, has been known to occur during the administration of this drug.
  • Neutropenia: This condition is characterized by a low number of white blood cells and weakened immune function. It can be a side effect of a number of cancer medications. The presence of neutropenia may mean having to stop or change Adcetris.
  • Opportunistic infections: This drug suppresses the immune system and can worsen viral, bacterial, or fungal infections, such as pneumonia, bacteremia, or sepsis.
  • Liver problems: Liver damage may make this drug unsafe to use.
  • Kidney problems: Kidney problems may make this drug unsafe.
  • Progressive multifocal leukoencephalopathy (PML): A neurological disorder, PML is characterized by the destruction of myelin, a substance that coats and protects nerve and brain cells.
  • Lung issues: Use of Adcetris has also been known to affect lung function, leading to dangerous and potentially fatal conditions such as pneumonitis (an inflammation of lung tissue) and acute respiratory distress syndrome (ARDS, in which fluid fills the lungs).
  • Gastrointestinal conditions: Since Adcetris can cause side effects to the gastrointestinal system, it is not recommended to be given to people who have a history of these conditions.
  • Pregnancy: Research on animals has found that the use of Adcetris may potentially cause harm to a developing fetus. As such, pregnant women will be advised of this risk prior to undergoing treatment. Women should avoid getting pregnant while taking this drug and for at least six months after the final dose.
  • Breastfeeding: Due to potential complications, mothers will be asked to cease breastfeeding during the course of treatment and for up to six months afterward.
  • Age: Those over the age of 65 are also at an increased risk of dangerous side effects, which may influence therapeutic decision-making.

Other Antibody-Drug Conjugates

Adcetris is just one of the class of antibody-drug conjugates, all of which work the same way: by targeting the CD30 protein found on cancer cells. Currently, seven others are approved by the Food and Drug Administration (FDA) for clinical use:

  • Kadcyla (ado-trastuzumab emtansine)
  • Padcev (enfortumab vedotin)
  • Enhertu (fam-trastuzumab deruxtecan-nxki)
  • Mylotarg (gemtuzumab ozogamicin)
  • Besponsa (inotuzumab ozogamicin) 
  • Polivy (polatuzumab vedotin-piiq)
  • Trodelvy (sacituzumab govitecan-hziy)

Dosage

Adcetris is administered at an outpatient infusion center or hospital via IV injection for 30 minutes at a time. The specific dosage depends on the condition being treated and may also be adjusted by your healthcare provider based on your case.

The following are FDA recommendations for dosage:

  • Stage III or IV cHL: Alongside chemotherapy, 1.2 milligrams (mg) per kilogram (kg) of body weight is recommended, with a maximum of 120 mg per day. Treatments are administered once every two weeks up to 12 times or until toxicity is unacceptable.
  • cHL after HCT: Following HCT, it’s recommended that healthcare providers wait four to six weeks before initiating Adcetris. Dosage in these cases is 1.8 mg per kg up to a maximum of 180 mg a day. This should be administered once every three weeks for up to 16 treatments, or until levels of toxicity in the body are unacceptable.    
  • Relapsed cHL: For relapsed cases of cHL, guidelines are: 1.8 mg per kg of body weight, and no more than 180 mg a day. This is done once every three weeks for a maximum of 16 treatments.
  • Systemic ALCL: For newly diagnosed systemic ALCL, 1.8 mg per kg of body weight is administered, with a daily maximum of 180 mg, alongside chemotherapy. Treatments occur once every three weeks for a maximum of six to eight sessions, or until other adverse effects are unacceptable.
  • Relapsed pcALCL/CD30-expressing mycosis fungoides: Cases of pcALCL or MF relapse are treated with doses of 1.8 mg per kg of body weight administered once every three weeks. This can be done for up to 16 treatments, or until toxicity becomes unbearable.

Keep in mind that the above are recommendations. Your healthcare provider may need to adjust dosages and schedules based on your health status or other factors.

Modifications

Dosages of Adcetris are modified based on body weight. In addition, dose strength is modified in the presence of certain conditions:

  • Liver diseases: Doses that are typically 1.2 mg per kg are reduced to 0.9 mg (for a maximum of 90 mg per day) in cases of mild impairment of the liver, and treatment ceases in more severe cases. Cases that would typically require the higher 1.8 mg per kg dose are reduced to 1.2 mg in the presence of minor liver damage, with treatment stopped if the liver gets worse.    
  • Peripheral neuropathy: Peripheral neuropathy is categorized based on severity, with grade 4 being the most severe and grade 1 being the least. Cases that would typically call for 1.2 mg per kg are reduced to 0.9 mg when you have grade 2 neuropathy, and treatment is stopped in cases of grade 3 or 4. Those that call for 1.8 mg per kg in conjunction with chemotherapy are cut back to 1.2 mg in grade 2 and 3 neuropathy.   
  • Neutropenia: Administration of Adcetris is paused in severe cases (grades 3 or 4) of neutropenia, and, oftentimes, other drugs need to be coadministered, especially when this drug is taken alongside chemotherapy.

Since this treatment is only administered via IV injection, patients don’t need to worry about storage or safe disposal.

Side Effects

Adcetris may lead to a range of side effects, from minor to severe, and even deadly. Throughout the course of your treatment, the healthcare provider will be monitoring for any adverse reactions.

Keep track of how you’re feeling, and don't ignore symptoms. If you're feeling sick or if anything seems off, make sure to let your healthcare provider know. Keep in mind: some reactions to this drug are medical emergencies.

Common

Side effects are frequently reported among those taking Adcetris.

The most common of these are:

  • Fatigue
  • Upper-respiratory infection
  • Nausea
  • Vomiting
  • Diarrhea
  • Anemia (lack of red blood cells in the body)
  • Fever
  • Stomach or abdominal pain
  • Weight loss
  • Constipation
  • Mouth sores
  • Tingling or numbness in hands or feet
  • Hair loss
  • Low white blood cell count (neutropenia)
  • Low blood platelet count (thrombocytopenia)

Severe

Certain reactions to Adcetris are medical emergencies and may require immediate attention. Among the more severe side effects of this drug are:

  • Infusion-related reactions: Shortness of breath, lowered blood pressure, chest pains, rash, and itchiness
  • Liver toxicity: Yellowing of the skin or eyes (jaundice), dark or brown urine, and abdominal pain
  • Tumor lysis syndrome: Nausea, vomiting, fatigue, or diarrhea
  • Stevens-Johnson syndrome: Rashes or painful blisters
  • Gastrointestinal tear/pancreatitis: Severe abdominal pain, swelling in the abdomen, chills, fever, constipation, nausea, or vomiting
  • Cardiac arrhythmia: Fatigue, weakness, dizziness, fainting spells, rapid heartbeat, shortness of breath, and chest pain, among other symptoms

If you’re feeling any of these symptoms or suspect you have these conditions, be sure to contact your healthcare provider right away or go to the emergency room.

Warnings and Interactions

Adcetris can be harmful when taken with other medications.

These include:

  • Xolagel (ketoconazole)
  • Norvir (ritonavir)
  • Verelan (verapamil)
  • Erygel (clarithromycin)
  • Erythrocin (erythromycin)
  • Tiazac (diltiazem)
  • Goldenseal
  • Grapefruit

It’s important to let your healthcare provider know what other drugs or substances you're taking during treatment.

Your healthcare provider and oncology team will be monitoring your status throughout your course and will let you know if the therapy should change. 

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. U.S. Food and Drug Administration. Highlights of prescribing information: Adcetris.

  2. American Cancer Society. What is Hodgkin lymphoma?.

  3. Memorial Slone Kettering Cancer Center. Autologous stem cell transplant: A guide for patients & caregivers. 

  4. National Center for Advancing Translational Studies, National Institutes of Health. Anaplastic large cell lymphoma.

  5. Lymphoma Research Foundation. Anaplastic large cell lymphoma.

  6. American College of Radiology. Lymphoma: diagnosis, evaluation and treatment.

  7. Editorial Board, ADC: Journal of Antibody-Drug Conjugates. Resources for clinicians.

  8. RxList. Side effects of Adcetris (brentuximab vedotin).

  9. US Food and Drug Administration. Table of substrates, inhibitors and inducers.

By Mark Gurarie
Mark Gurarie is a freelance writer, editor, and adjunct lecturer of writing composition at George Washington University.