Could bystander killing contribute significantly to the antitumor activity of brentuximab vedotin given with standard first-line chemotherapy for Hodgkin lymphoma?

MP Brown, AH Staudacher - Immunotherapy, 2014 - Future Medicine
MP Brown, AH Staudacher
Immunotherapy, 2014Future Medicine
Evaluation of: Younes A, Connors JM, Park SI et al. Brentuximab vedotin combined with
ABVD or AVD for patients with newly diagnosed Hodgkin's lymphoma: a Phase 1, open-
label, dose-escalation study. Lancet Oncol. 14 (13), 1348–1356 (2013). With exceptionally
high response rates, the CD30-directed antibody–drug conjugate brentuximab vedotin (BV)
was US FDA approved for treatment of patients with relapsed/refractory Hodgkin lymphoma
(HL). Now in Phase I clinical trial, it has been shown that combining BV with multiagent …
Evaluation of: Younes A, Connors JM, Park SI et al. Brentuximab vedotin combined with ABVD or AVD for patients with newly diagnosed Hodgkin's lymphoma: a Phase 1, open-label, dose-escalation study. Lancet Oncol. 14(13), 1348–1356 (2013). With exceptionally high response rates, the CD30-directed antibody–drug conjugate brentuximab vedotin (BV) was US FDA approved for treatment of patients with relapsed/refractory Hodgkin lymphoma (HL). Now in Phase I clinical trial, it has been shown that combining BV with multiagent chemotherapy (excluding bleomycin) as first-line treatment in HL patients with high-risk disease is feasible. Complete response rates were over 90% and toxicity was manageable. Given that the malignant cell population comprises a minority of HL lesions, and that BV releases a diffusible cytotoxin via a cathepsin B-cleavable linker, we argue that a significant proportion of the antitumor activity of BV can be attributed to bystander cytotoxicity in addition to direct killing of CD30-expressing malignant cells.
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