Bleomycin VS Brentuximab

Welcome to you kloeber.

I had Bleomycin for 12 infusions, around maximum lifetime dose. It is a core drug in the popular ABVD combination against Hodgkin's, but has a few other common applications.  It is also one of the oldest chemo drugs, but that does not count against its effectiveness; it is extremely effective at what it does. The first chemo drug ever developed, Mustargen, was discovered in 1942, but is still in common use today against lymphoma and leukemia, which is what it was investigated for by the Army and Sloan-Kettering during WW II.  Hence, many of the best chemo agents are also some of the oldest. Bleomycin is listed as a World Health Organization (WHO) critical drug -- a list of the world's most important medications.

Brentuximas is relatively new, FDA approved in 2011. I have never received it. It was first approved for refactory classical Hodgkin's, meaning Hodgkins that was not responding to other therapies.  Over time, all of these drugs are eventually tested on other lymphomas, and approved for other uses. Today Brentuximas has four or more common uses, but they seem to all still be against classical forms of HL, of which there are 4. It is also used against T-cell lymphoma, a NHL set of diseases, which is profoundly rare and difficult to treat.

Brent... , because it ends with the letters  "....mab" is obviously a "monoclonal antibody," the most famous of which is Rituxan (Rituximab).  'MAB' stands for 'monoclonal anti-body'.  But while Rituxan kills the CD-20 cell (a type of protein), Brentuximab attacks CD-30 cells, a defining cell in classical Hodgkin's disease.

But, Brentuximab is ALSO listed as a cytotoxic agent, or neoplastic agent. In other words, besides being a MAS drug, it is simultaneously a "conventional chemo." (Rituxan is not a cytotoxic agent.)  This suggests to me that Brent.... may potentially be quite harsh itself.

Bleomycin, while powerful against HL, is harsh and somewhat dangerous.  It causes lung toxicity is around 15% of all users, from which most or nearly all recover after use, and lung fibrosis in 1 to 2% of all users, from which there is no cure or recovery.   Lung damage and severe cough are the most common, severe reactions to it.  So, breathing difficulty would probably be a good reason to switch, as your doctor did.  Attached is a data sheet on the Brent....  To open it, first highlight the link, the right click, then click on "Go to...."

What strain of HL do you have ?  Are you on a combination therapy ? (AVBD or some other)

There has not been a lot of discussion regarding Brentuximas, so predicting clinical course is tough. But the side-effects listed are the usual:  skewed blood counts, weakness, nausea.  IF you are getting a combination therapy of several drugs, it then becomes next to impossible to say which is causing which side-effects, since most chemos share a few of the classic, common reactions.  But breathing difficulty is a Bleomycin hallmark.

Most long-term, multi-drug treatments are a march through hell. Side-effects almost always increase their intensity with more applications, so how you feel today is not necessarily how you will feel in a few months, if you receive treatments that long.  Some people do better than others, but it is never pleasant. WEAKNESS is the most common, virtually universal reaction. And oncologists stress that the severity of side-effects is no indication, for or against, of the cancer-killing effectiveness in any given patient.

I am not a killjoy; just sharing most common trends among patients. Rarely but on occasion a patient will relate that they skated through chemo like a figure skater at the Winter Olympics. Rare, but not unhear of.

May you be a skater !

I hope this intro is of value to you,

max

http://chemocare.com/chemotherapy/drug-info/brentuximab-vedotin.aspx