|The following article features coverage from the American Society of Hematology 2019 meeting. Click here to read more of Cancer Therapy Advisor‘s conference coverage.|
Adding brentuximab vedotin and rituximab to combination risk-adapted chemotherapy without cyclophosphamide, etoposide, or bleomycin was associated with reduced treatment toxicities among patients with newly diagnosed Hodgkin lymphoma (HL), researchers reported in an abstract presented at the 61st American Society of Hematology (ASH) Annual Meeting and Exposition in Orlando, Florida.
The combination “appears to be safe in children, adolescents, and young adults,” concluded lead author Jessica C. Hochberg, MD, of the New York Medical College in Valhalla, NY, and colleagues.
“Our results show significant promise with a CR [complete response] rate of 100%, 58% rapid early response, and significant reduction in the use of toxic chemotherapy and radiation,” Dr Hochberg and colleagues reported. “The EFS/OS [event-free survival/overall survival] to date is 100% with a median follow up time of greater than 3.5 years.”
Chemoradiotherapy yields high cure rates for newly diagnosed HL but is associated with significant cardiotoxicity, neurocognitive problems, secondary cancers, and poor patient quality of life.
“Pediatric cancer survivor studies have shown significant increases adverse health events following therapy throughout adulthood,” the authors noted. “Major risk factors for late effects include significant exposure to radiation, anthracyclines, cyclophosphamide, etoposide, and bleomycin.”
Immunotherapy has proven effective against relapsed HL and brentuximab vedotin, an anti-CD30 antibody-drug conjugate, is approved by the US Food and Drug Administration for first-line treatment of adult HL in combination with standard chemotherapy. To study the safety of brentuximab vedotin and the chimeric anti-CD20 monoclonal antibody rituximab in combination with reduced-toxicity risk-adapted chemotherapy in children, adolescents and young adults, the authors enrolled 33 patients aged 4 to 23 years at diagnosis. Twelve of the patients were male and 21 were female. Four patients were risk-stratified as low-risk (Stage IA, IIA, no bulky disease), 17 as intermediate-risk (Stage IA bulk/E, IB, IIA bulk, IIB or IIIA), and 12 as high-risk (Stage IB bulk/E, II bulk, IIIA bulk, IIIB, IV).
“Low risk patients were given 3 cycles of brentuximab vedotin (1.2 mg/kg) with doxorubicin (25 mg/m2), vincristine (1.5 mg/m2), prednisone, and dacarbazine (375 mg/m2) on days 1 and 15. Intermediate- and high-risk patients received 4 or 6 cycles of brentuximab vedotin, doxorubicin, vinblastine, dacarbazine, and rituximab (375 mg/m2) on days 1, 2, and 15, 16,” the authors reported.
Eighteen patients (58%) demonstrated rapid early response, assessed using PET/CT scans. Four patients (12%) in CR required radiotherapy for bulky disease with slow early responses, the authors reported.
Event free survival and overall survival were 100% at a mean follow-up of 44 months.
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Hochberg JC, Basso J, Klejmont L, et al. Reducing the burden of chemoradiotherapy with the combination of brentuximab vedotin and rituximab with reduced toxicity chemotherapy in children, adolescents and young adults with newly diagnosed Hodgkin lymphoma. Presented at: 61st American Society of Hematology (ASH) Annual Meeting and Exposition; December 7-10, 2019: Orlando, Florida. Abstract 127.