Brentuximab [BRE7]

Re-use of brentuximab in relapsed/refractory Hodgkin lymphoma ADULT patients:

  1. An application has been made by and the first cycle of systemic anti-cancer therapy is to be prescribed by a consultant specialist specifically trained and accredited in the use of systemic anti-cancer therapy
  2. The patient has relapsed or refractory CD30+ Hodgkin lymphoma.
  3. The patient has relapsed Hodgkin lymphoma after autologous stem cell transplant
  4. Previous use of brentuximab achieved a partial/complete response to brentuximab
  5. Brentuximab is being used as a bridge to allogeneic stem cell transplantation or donor lymphocyte infusion
  6. Treatment with brentuximab will be discontinued after 4 cycles if CT or PET-CT scans to assess response demonstrate a response status of less than a partial or a complete response in
  7. The patient is an adult* *note there is a separate blueteq form to be used for brentuximab in this indication in children
  8. No planned treatment breaks of more than 6 weeks beyond the expected cycle length are allowed (to allow any toxicity of current therapy to settle or intercurrent comorbidities to improve). *Requests for continuation of treatment after unplanned treatment breaks over this duration should be made via the treatment break approval process
  9. A maximum of 16 cycles of brentuximab will be administered to the patient when combining this reuse and previous cycles of brentuximab
  10. Brentuximab will otherwise be used as set out in its Summary of Product Characteristics (SPC).

[NHS funded]{.badge .rounded-pill .bg-success} From: 26 September 2017

Form version:

CDF Managed Access: NA

NICE Technology Appraisal: (formerly TA446) (13 June 2018)

Current Form Version

Important

This is an older version of the form. To view the most up to date form follow this link

Older Form Versions

There are previous versions of this form. These may not all be available on this site.