A bit of a guarded opinion on Adcetris. The title of the piece is "Brentuximab Vedotin and Panobinostat: New Drugs for Hodgkin's Lymphoma—Can They Make One of Medical Oncology's Chemotherapy Success Stories More Successful?", by George Canellos (J Clin Oncol 30:2171-2172, 2012). I've pasted the conclusion in below:
"There is still a paucity of clinical trial data on brentuximab vedotin. More is needed in the area of toxicity, especially neurotoxicity and possible interaction with the vinca alkaloids. As mentioned, bleomycin should be omitted when this agent is used because of possible increased lung toxicity. In addition, there is some suggestion that bleomycin in the ABVD regimen has questionable impact on HL. Despite its exciting antitumor activity for both HL and ALCL, brentuximab vedotin's cost will add considerably to the current expense of systemic therapy. Third-party payers will pay close attention to the evidence of benefits in its administration. The convincing evidence can only be derived from prospective randomized clinical trials that test the additive value of the new agent. These will be essential because we seem to be entering a new era of anticancer drug use based on cost and effectiveness. The current standard regimens are relatively inexpensive as the drugs are primarily generic, so brentuximab vedotin's cost has to be justified by improved outcomes in the settings mentioned."
So the choice between cheaper and side effects that can be worse than the cure v expensive, less side effects (hopefully) and works (hopefully) is where we are at. Hate to be in the position now with having to make that choice.
How long before we know the results of eliminating bleomycin and replacing it with A?
Good luck to all who have to make that choice now.
Unfortunately, we would have to wait until the label expansion is approved by the FDA. It could take years to collect the data and process it through the FDA review committee. On the bright-side, doctors can still use it off-label for patients who can pay up. I ask - what is wrong with our medical system?