Brentuximab in the Treatment of CD30-Positive Enteropathy-Associated T-Cell Lymphoma

Abstract

Enteropathy-associated T-cell lymphoma (EATL) is a rare aggressive lymphoma that confers a poor prognosis with current treatment strategies. Given the rarity of this disease, prospective randomized trials are limited, and thus a standard validated treatment strategy is lacking. This report presents the disease course of a patient with EATL who was treated with single-agent brentuximab vedotin, an anti-CD30 conjugated antibody. (JNCCN 2013;11:137-140) NCCN: Continuing Education Accreditation StatementThis activity has been designated to meet the educational needs of physicians and nurses involved in the management of patients with cancer. There is no fee for this article. No commercial support was received for this article. The National Comprehensive Cancer Network (NCCN) is accredited by the ACCME to provide continuing medical education for physicians.NCCN designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.NCCN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center`s Commission on Accreditation.This activity is approved for 1.0 contact hour. Approval as a provider refers to recognition of educational activities only and does not imply ANCC Commission on Accreditation approval or endorsement of any product. Accredited status does not imply endorsement by the provider of the education activity (NCCN). Kristina M. Gregory, RN, MSN, OCN, is our nurse planner for this educational activity.All clinicians completing this activity will be issued a certificate of participation. To participate in this journal CE activity: 1) review the learning objectives and author disclosures; 2) study the education content; 3) take the posttest with a 70% minimum passing score and complete the evaluation at http://education.nccn.org/ node/11515; and 4) view/print certificate. Learning ObjectivesUpon completion of this activity, participants will be able to:• Describe the rationale for the management methods used in this case presentation.• Describe the ideal management of a patient taking brentuximab for the treatment of CD30-positive enteropathyassociated T-cell lymphoma. Ms. Harrold has disclosed that she has no relevant financial relationships. Kristina M. Gregory, RN, MSN, OCN, Vice President, Clinical Information OperationsMs. Gregory has disclosed that she has no relevant financial relationships. Case ReportA 64-year-old man presented with an acute small bowel obstruction that was preceded by a few months' history of intermittent diarrhea, fever, and weight loss. Pathology of the small bowel resection was consistent with enteropathy-associated T-cell lymphoma (EATL) that expressed CD3 and CD30; was negative for CD4, CD8,

Recent advances in intestinal lymphomas

“…The neoplastic cells are usually cCD3 + , CD5 − , CD4 − , CD8 − and CD56 − , and diffusely express cytotoxic markers with an activated profile (TIA1, granzyme B and/or perforin) . Most cases are CD30 + and interestingly, complete remission was reported recently in a patient with CD30 + EATL after brentuximab vedotin administration . The neoplastic cells are EBV‐negative, and usually express T‐cell receptors (TCR)‐αβ and the intraepithelial homing integrin CD103 …”

A rare but potentially fatal cause of diarrhoea and weight loss: enteropathy-associated T-cell lymphoma

“…Studies of allogenic stem cell transplant in relapsed and refractory aggressive non-Hodgkin lymphoma suggest that it could have a role in treatment, although it is unclear whether this could be extrapolated to EATL 20 21. Some authors have also suggested that newer therapies such as monoclonal antibodies and apoptosis inducing small molecules may be used to treat EATL in the future, and there has been success in individual cases 12 22. There appears to be a very limited role for surgery and radiotherapy, to be used for debulking and resection of masses with high risk of obstruction, based on clinical judgement 2.…”

Emerging new anticancer biological therapies in 2013 (haematological malignancies)

“…A phase I study comparing the safety of brentuximab vedotin combined to either ABVD or AVD chemotherapy found a high number of pulmonary toxicity in the ABVD arm [54]. Brentuximab vedotin has also shown clinical efficacy in anaplastic large cell lymphoma and case reports indicate efficacy in other CD30þ aggressive lymphomas such as enteropathy type T-cell lymphoma and preclinical evidence suggests a potential role in the treatment of primary effusion lymphoma [55][56][57].…”