Is nivolumab an effective treatment for relapsed and unresponsive Hodgkin lymphoma?

This study examined if nivolumab is an effective treatment for relapsed and unresponsive Hodgkin lymphoma. This study concluded that nivolumab is an effective treatment for these patients, regardless of previous stem cell treatment status.

Standard treatment for patients with Hodgkin lymphoma (HL) which has relapsed or not responded to treatment includes high dose chemotherapy. This may include brentuximab vedotin (BV), a monoclonal antibody. This type of treatment binds to cancer cells, leading to cancer cell death. This is often followed by autologous stem cell transplantation (ASCT). ASCT is a procedure where healthy blood-forming cells (stem cells) are removed from a patient, stored, and later given back to that same person. These replace cells that have been destroyed by disease or toxic treatment. Patients who fail to respond to ASCT tend to have a poor prognosis.

Nivolumab (Opdivo) is a drug that helps the immune system to kill cancer cells. It is not known how effective nivolumab is in treating patients with HL, who have relapsed or not responded to previous treatment.

This study included 99 adults with relapsed or non-responsive HL. They received nivolumab every 2 weeks. 40 patients had previously received ASCT with or without BV. 59 patients had failed previous treatment and had not undergone ASCT. 

The average length of follow up was 21 months. At this point, 96% of patients were still alive. 48.5% of patients had not experienced progression of HL. The average length of survival without progression of HL was 19.4 months.

64% of patients responded to treatment. 31% of patients had a complete response (CR; no sign of HL on scans or blood tests). 33% of patients had a partial response (PR; a reduction in the size of the cancer. In 5% of patients, the disease had stabilised (was not getting better or worse). 20% (20) of patients had an ‘Indeterminate response’. In these patients, further scans were required to assess if they were having a reaction to the medication, or if the cancer was growing. There was no relationship between the type of treatment patients had previously received, and their response to nivolumab. 

Nivolumab was stopped in 94% of patients. 18% of patients have had no further treatment, and remain in CR. 65% of the patients received further treatment after nivolumab. 13% underwent ASCT. 

88% of patients experienced side effects during treatment. 17% of these were moderate to severe. 

This study concluded that nivolumab is an effective treatment for relapsed and unresponsive Hodgkin lymphoma, regardless of previous stem cell treatment status.

This report included a relatively small number of patients. Further studies are needed.