Nivolumab a promising treatment option in heavily pretreated cHL patients
Nivolumab demonstrates therapeutic potential in patients with classical Hodgkin’s lymphoma (cHL) refractory to brentuximab vedotin and may also serve as a bridge to transplantation while having a manageable toxicity, according to a study.
Researchers retrospectively examined 82 relapsed/refractory cHL patients (median age 30 years) who were treated with nivolumab. The median follow-up was 7 months, and the patients received a median of five previous lines of therapy (77 percent received brentuximab vedotin; 70 percent underwent stem cell transplantation).
Data revealed that objective response rate among 75 patients evaluated after 12 weeks of nivolumab treatment was 64 percent, with 16 patients achieving complete response. After 16 weeks, objective response dropped to 60 percent, with similarly 16 patients showing complete response. Subsequent transplantation was performed in 20 patients.
Among 11 patients who received allogeneic stem cell transplantation, five demonstrated complete response at the time of transplantation and are currently alive with ongoing response.
At the time of analysis, 41 patients persisted with nivolumab. The primary reason for nivolumab discontinuation was disease progression (n=19). The 6-month overall and progression-free survival rates were 91.2 percent (95 percent CI, 0.83 to 0.96) and 77.3 percent (0.66 to 0.85), respectively.
Nivolumab exhibited an acceptable safety profile, with only four patients requiring treatment discontinuation due to serious adverse events (autoimmune encephalitis, pulmonary adverse event, and two cases of graft versus host disease aggravation). A total of 10 patients died during the follow-up, with one case of death considered to be treatment-related.
CHL is considered a curable disease, with approximately 80 percent of patients achieving sustained remission after first-line treatment. However, relapse occurs in about one-third of responders, and some (15 percent) do not even respond to both first- and second-line therapies. Prognosis is particularly worse in patients relapsing following stem cell transplantation, and while brentuximab vedotin may be useful, the median progression-free survival for patients refractory to the agent is only 3.5 months. [Expert Rev Hematol 2013;6:1-3; J Clin Oncol 2012;30:2183-2189; Ann Oncol 2016;27:1317-1323]
Given the prognosis of patients refractory to brentuximab vedotin and/or stem cell transplantation, programmed death-1 blockers represent candidate treatments for heavily pretreated cHL, albeit with an increased risk of toxicity, researchers said.