Brentuximab vedotin plus nivolumab in older or chemotherapy-ineligible patients with Hodgkin lymphoma

This study aimed to investigate the safety and effectiveness of brentuximab vedotin (BV; Adcetris) and nivolumab (Opdivo) in older patients with Hodgkin lymphoma (HL) or younger patients unsuitable for standard treatment.  

This study concluded that this treatment may benefit these patients.  

The standard treatment for patients with HL is ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) chemotherapy. A great number of patients can be cured with this regimen. However, patients with HL who are older (over 60 years) commonly have lower response rates, poorer survival outcomes, and greater toxicity than younger patients.  

BV is an immune therapy for patients with relapsed/refractory Hodgkin lymphoma (r/r HL). Nivolumab is also an immune therapy that can be used for HL treatment. A combination of BV and nivolumab has shown activity in patients with r/r HL. 

It was unknown if the combination of BV and nivolumab would be safe and effective in older patients with HL or younger patients unsuitable for standard ABVD therapy. 

This study involved 46 patients with previously untreated HL. 96% of patients involved were over 60 years, while 4% were under 60 years and not suitable for standard treatment. Patients were treated with BV and nivolumab. 76% of patients completed all 8 cycles of treatment. The average follow-up period was 21.2 months. 

Of all 46 patients, 48% achieved a complete metabolic response (CMR – no evidence of disease) and 13% achieved a partial metabolic response. The overall response rate for these patients was 61%. 75% of these patients had maintained their response for at least 6 months (61%) or 12 months (50%). 

After an average of 21.2 months, 70% of the patients were free of cancer progression. 94% of patients were alive at this time. The average time without cancer progression was 18.3 months.

48% of all patients had peripheral neuropathy (nerve damage) as a side effect. Severe and life-threatening side effects included increased liver and pancreas enzymes, and pancreatitis.  

This study concluded that brentuximab vedotin and nivolumab was active in older patients with HL or younger patients unsuitable for standard treatment.  

This study was terminated early because the authors had estimated a higher response rate due to the higher activity of BV alone. However, this study had more patients with additional medical conditions that may have affected the effectiveness of the treatment.