Relapsed or refractory Hodgkin lymphoma: how does stopping and restarting nivolumab impact patient outcomes?

This study aimed to evaluate the safety and effectiveness of stopping and restarting nivolumab (Opdivo) in patients with relapsed or refractory (r/r) classical Hodgkin lymphoma (cHL).  

The authors concluded that nivolumab retreatment is well tolerated and effective in patients who achieved complete response (CR; complete disappearance of all signs of cancer) after initial nivolumab therapy.

A high number of patients with HL experience relapse (worsening of the disease) or refractory (not responsive) disease to standard treatments.

Immune checkpoint inhibitors (ICI) are a type of immunotherapy. ICIs prevent the immune system from switching off. This allows the immune system to target and kill cancer cells. Nivolumab is an ICI used in the treatment of r/r cHL. The safety, effectiveness, and time span of nivolumab retreatment in r/r cHL remain under investigation.

23 adult patients with r/r cHL who achieved CR after initial nivolumab therapy were recruited for this study. Patients were retreated with nivolumab for r/r disease. The average follow-up after nivolumab was stopped the first time was 28.9 months. It was 14.8 months after retreatment.

After nivolumab retreatment, 33% of patients experienced CR, 33% experienced a partial response (PR; the extent of the cancer decreased) and 33% experienced indeterminate response (IR; response to treatment is unclear).

The average number of nivolumab retreatment cycles that gave the best response was 6. The average time taken for patients to achieve the best response was 3.6 months. At the end of this study, 68.8% of patients who achieved CR at 3 months were alive without cancer worsening. At the end of the study, 100% of patients were alive.

Severe side effects were reported by 36% of patients retreated with nivolumab. These included joint pain, fever, low platelet levels, and pneumonia.

This study showed that stopping and restarting nivolumab was a suitable, safe, and well tolerated for patients with r/r cHL.

This study took place in one research center with a limited number of patients. Further studies in a larger population of patients is required.