Does anti-PD1 therapy change the effectiveness of chemotherapy in unresponsive Hodgkin lymphoma?

This study aimed to investigate the effects of chemotherapy alone or chemotherapy plus anti-PD1 therapy in patients with relapsing/refractory (RR) Hodgkin's Lymphoma. The main finding was that anti-PD1 treatment enhances the effectiveness of chemotherapy in these patients.

Stem cell transplant (SCT) and brentuximab vedotin (BV; Adcetris) are common treatments for Hodgkin lymphoma (HL). SCT involves the transfer of stem cells to the patient from a donor. BV is a targeted therapy. This means that it kills only tumor cells. Many patients with HL are cured by these treatments. However, some may not respond to treatment (refractory) and other may lose response over time (relapsing). Nivolumab (Opdivo) and pembrolizumab (Keytruda) also known as anti-PD1 therapies, are targeted therapies. Patients with relapsing/refractory (RR) HL are commonly given anti-PD1 therapies after failure of STC and BV therapy. However, these therapies are likely to fail after one year.  It is necessary to investigate the effects of different combinations of therapies for RR HL.

Thirty patients with R/R HL were included. Seventy percent of patients had undergone SCT and 93% had been treated with BV before receiving anti-PD1 treatment. Disease progression (DP – cancer getting worse despite treatment and partial response (PR – only partly responding to the treatment) were measured. Twenty-four (80%) patients had DP and 6 (20%) had PR after anti-PD1 therapy. Of those that had DP, 17 (73%) were treated with chemotherapy alone and 7 (27%) were given chemotherapy plus anti-PD1. Patients were followed for an average of 12.1 months after CT.

Twelve patients treated with the same chemotherapy responded. Of the patients who received chemotherapy alone, 7 (42%) showed no signs of cancer, 3 (16%) had a PR and 7 (42%) had DP. Of those that received chemotherapy plus anti-PD1, 4 (70%) showed no signs of cancer and 2 (25%) had a PR. Six patients who responded then underwent SCT. The average length of time before the cancer got worse after CT was 11 months.

This study suggests that anti-PD1 treatment increases the effects of chemotherapy in patients with Hodgkin's Lymphoma who are unresponsive following SCT or BV therapy.

This study had a small sample size which may have affected results.

If you have questions about managing Hodgkin's Lymphoma, please ask your doctor.