Brentuximab Vedotin for Patients With Refractory Lymphomatoid Papulosis: An Analysis of Phase 2 Results

Abstract

Importance: Brentuximab vedotin is a monomethyl auristatin E-conjugated monoclonal antibody directed against CD30. It represents a potential treatment for the CD30+ lymphoproliferative disorder lymphomatoid papulosis (LyP), which currently has no approved treatment.

Objective: To assess the efficacy and safety of brentuximab vedotin for the treatment of LyP.

Design, setting, and participants: In this study conducted at The University of Texas MD Anderson Cancer Center from May 10, 2011, to March 31, 2017, a total of 12 patients with LyP received brentuximab vedotin. All patients were 18 years or older with a diagnosis of LyP and were also required to have scarring, more than 10 lesions, or active lesions on the face, hands, or feet. Nine patients were enrolled in a physician-initiated, open-label, single-center, phase 2 clinical trial of brentuximab vedotin for CD30+ cutaneous T-cell lymphomas and LyP from 2011 to 2013. Three patients were later treated outside of the trial from 2013 to 2017. Five patients continued to be followed up as of March 2017.

Interventions: Intravenous brentuximab vedotin 1.8 mg/kg infused over 30 minutes every 21 days.

Main outcomes and measures: The primary end point was the overall response rate. Complete response was defined as zero lesions, and partial response was defined as a 50% or greater reduction in lesion count from baseline. A relapse was defined as loss of partial response.

Results: All 12 patients (8 men and 4 women; median age, 46 years) responded to brentuximab vedotin, and 7 exhibited a complete response. Time to response was 3 weeks in all patients. The median duration of response was 20 weeks (range, 6-103 weeks). For 5 patients who relapsed, the median time to relapse was 12 weeks (range, 6-41 weeks). One patient who relapsed was retreated and has remained in partial response for more than 23 months. Grade 1 to 2 neuropathy occurred in 10 patients but resolved in 5. Adverse events of grade 3 or higher were neutropenia (n = 2) and dizziness/vertigo (n = 1). Three patients withdrew owing to adverse events.

Conclusions and relevance: Brentuximab vedotin is effective in treating LyP (overall response rate, 100%; complete response rate, 58%), but its use should be reserved for patients with truly severe and refractory LyP. More work is needed to optimize its dosing to minimize adverse events, such as peripheral neuropathy.

Trial registration: clinicaltrials.gov Identifier: NCT01352520.

Conflict of interest statement

Conflict of Interest Disclosures: Drs Huen and Duvic reported receiving research funding from Seattle Genetics. No other disclosures were reported.

Figures

Figure 1.. Lymphomatoid Papulosis in Patient 4 While Taking Brentuximab Vedotin

Patient 4 exhibited 53 papules throughout her body at baseline. After 2 doses of brentuximab vedotin, her lesions had all resolved. She experienced a mild flare during cycle 7, day 1 but has since maintained a partial response for more than 60 months.

Figure 2.. Duration of Response to Brentuximab Vedotin (BV)

Swimmer plot of all 12 patients with lymphomatoid papulosis who received BV.