Pembrolizumab followed by AVD treatment in newly diagnosed advanced classical Hodgkin lymphoma

This study aimed to investigate the safety and effectiveness of pembrolizumab (Keytruda) followed by AVD (doxorubicin, vinblastine, and dacarbazine) treatment in patients with high-risk classical Hodgkin lymphoma. 

This study concluded that this treatment was safe and effective in these patients.  

Pembrolizumab is a type of targeted therapy called a monoclonal antibody. It improves the immune system response to detect and kill cancer cells. It has shown to be effective in relapsed/refractory (R/R) classical Hodgkin lymphoma (cHL). AVD is a standard chemotherapy regimen used in newly diagnosed patients with cHL. 

It was unknown if pembrolizumab followed by AVD chemotherapy was a safe and effective treatment for patients with newly diagnosed high-risk cHL. 

This study involved 30 patients with newly diagnosed cHL. 40% had early unfavorable cHL and 60% had advanced-stage cHL. 40% of patients had large mediastinal (chest) masses and/or bulky disease (>10 cm). Patients were treated with 3 cycles of pembrolizumab alone followed by 4-6 cycles of AVD. Complete metabolic response (CMR – no signs of cancer) was evaluated through PET/CT scans. 

After pembrolizumab therapy, 37% of patients showed CMRs and 25% of patients had greater than 90% reduction in metabolic tumor volume. 100% of patients achieved CMR following 2 cycles of AVD.  

After an average follow-up of 22.5 months, there were no changes in therapy, progressions, or deaths. No patients needed consolidation radiotherapy (kills any cancer cells left after treatment), including those with bulky disease.  

The most common immune-related side effects were mild to moderate infusion reactions. One patient had a reversible severe high level of liver enzymes and a second had a reversible Bell’s palsy (temporary weakness or paralysis of facial muscles).  

This study concluded that pembrolizumab followed by AVD is highly effective and safe in newly diagnosed cHL patients including those with bulky disease. 

This study had a small number of participants and a short follow-up period. Also, there was no control treatment group. Further studies are needed. This study was supported by Merck, the manufacturer of pembrolizumab.