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Posted by on Sep 4, 2017 in Hodgkin's lymphoma | 0 comments

In a nutshell

This study looked at the use of brentuximab vedotin (Adcetris), nivolumab (Opdivo), and pembrolizumab (Keytruda) in treating patients with relapsed or refractory Hodgkin lymphoma. The study concluded that all three medications are very effective at treating patients with relapsed or refractory Hodgkin lymphoma. 

Some background

Hodgkin lymphoma (HL) is generally considered a curable disease. However, some patients will not respond well to initial treatment (refractory HL). Some patients will relapse after first-line treatment.

The usual treatment for patients with relapsed or refractory HL (rel/ref HL) is high-dose therapy and autologous stem cell transplantation (auto-SCT; using stem cells from the patient’s own body). The outcomes for patients who undergo auto-SCT has improved with the introduction of new treatments. These treatments include brentuximab vedotin (BV), nivolumab, and pembrolizumab.

More research is needed about how long these new drugs should be used, and whether or not they work with other second-line treatments, such as allogenic SCT (allo-SCT; using stem cells from a matched donor). 

Methods & findings

This study is a review of the effectiveness of BV, nivolumab, and pembrolizumab treatment for patients with relapsed or refractory HL.

Brentuximab Vedotin: BV is used both before and after auto-SCT. One study included 37 patients with rel/ref HL treated with BV before auto-SCT. 68% of patient showed a response to treatment, with 35% achieving a complete response (no sign of active disease). 49% received additional chemotherapy. 89% then underwent auto-SCT. 

In another study, 329 patients were randomized to receive BV or a placebo (treatment with no medication in it) after receiving auto-SCT. The average progression free survival (time from treatment to disease progression or death) for patients treated with BV was 42.9 months. The average progression free survival for patients treated with the placebo was 24.1 months. The difference was significant.

BV has also been shown to be effective when used in combination with second-line chemotherapy.

Before BV was introduced, the average length of survival for patients who failed auto-SCT treatment was 25 months. After BV, the average length of survival is 90 months.

BV has been successfully used before allo-SCT, and may reduce the risk of graft-versus-host disease.

Nivolumab and Pembrolizumab: Both medications are very active in patients who have rel/ref HL. One study looked at treating patients who failed both auto-SCT and BV with nivolumab. 66.3% of patients had a measurable response. In a similar study that used pembrolizumab, 71% of patients had a measurable response to treatment.

Nivolumab and pembrolizumab are not currently recommended as treatment before allo-SCT because of the potential increased risk of graft-versus-host disease. This is a condition where the transplanted cells begin attacking healthy tissue. 

The bottom line

The authors concluded that BV, nivolumab, and pembrolizumab are effective treatments for patients with relapsed or refractory Hodgkin lymphoma.

The fine print

Additional studies are being done that look at introducing brentuximab vedotin, nivolumab, and pembrolizumab earlier in HL treatment.

Published By :

Current hematologic malignancy reports

Date :

May 09, 2017

Original Title :

Where Do the New Drugs Fit in for Relapsed/Refractory Hodgkin Lymphoma?

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