Important Benefit for Small Population Is a Major Milestone in Lymphoma

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Anas Younes, MDThe approval of brentuximab vedotin (Adcetris) is a major milestone for the treatment of patients with relapsed Hodgkin lymphoma and anaplastic large cell lymphoma. It represents an excellent example of personalized cancer therapy. Patients are preselected based on a predictive biomarker that is expressed by tumor cells, which is the CD30 receptor. This CD30 biomarker identifies approximately 11,000 newly diagnosed patients with Hodgkin lymphoma and anaplastic large cell lymphoma out of a larger pool of patients, almost 80,000, who are diagnosed annually in the United States with different types of lymphomas. Both Hodgkin lymphoma and anaplastic large cell lymphoma are highly curable types of lymphoma, and it is estimated that less than 2,000 patients will not respond to or relapse from the intended curative therapy. It is this smaller pool of patients with CD30-expressing Hodgkin lymphoma and anaplastic large cell lymphoma who stand to benefit from the current FDA-approved indication.

Given the high cost of drug development for cancer, it is therefore not surprising that for decades pharmaceutical companies neglected drug development for this relatively narrow indication and small market. In fact, the last drug approved by the FDA for the treatment of Hodgkin lymphoma was almost 34 years ago. However, many of us, including myself, believe that because of the high response rates achieved with brentuximab vedotin with relatively low toxicity, in patients with multiply relapsed Hodgkin lymphoma and anaplastic large cell lymphoma, it has the potential of making a larger impact in future trials that will incorporate this drug in front-line regimens. Patients and doctors are encouraged to participate in the planned front-line studies so we can asses the impact of brentuximab vedotin on the natural history of these rare lymphomas. ■

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