Brentuximab Vedotin ‘May Optimise’ Hodgkin’s Lymphoma Patients for HDT/ASCT

Hodgkin’s lymphoma patients undergoing second-line therapy may benefit from treatment with brentuximab vedotin before high-dose therapy and autologous stem-cell transplantation

medwireNews: Brentuximab vedotin may allow patients with relapsed or refractory Hodgkin’s lymphoma to achieve positron emission tomography (PET)-negative scans before beginning high-dose therapy and autologous stem-cell transplantation (HDT/ASCT), phase II results suggest.

The sequential salvage strategy, based on the CD30 Antibody–drug conjugate, “could optimise the chance of cure after HDT/ASCT”, say Alison Moskowitz and team, from Memorial Sloan Kettering Cancer Center in New York, USA, in The Lancet Oncology.

In all, 45 patients with relapsed or refractory Hodgkin’s lymphoma after initial doxorubicin-based chemotherapy were given weekly infusions of brentuximab vedotin (1.2 mg/kg on days 1, 8 and 15 of a 28-day cycle for two cycles) followed by a PET scan.

PET scan results were negative for 12 (27%) patients and these individuals immediately moved onto HDT/ASCT, the researchers explain.

A further 32 patients with positive PET scans after brentuximab vedotin were given intensive chemotherapy consisting of ifosfamide, mesna, carboplatin and etoposide (augmented ICE), after which PET results were negative for 22 patients, but remained positive for 10. All patients then underwent HDT/ASCT.

Thus, 76% of patients were able to begin HDT/ASCT with a negative PET scan, the team reports.

After 2 years, overall and event-free survival rates were 95% and 80%, respectively, for the whole patient group. The corresponding event-free rates significantly differed between the patients who were PET-negative immediately after brentuximab vedotin or after augmented ICE compared with PET-positive patients, at 92%, 91% and 46%, respectively.

“Our study substantiates the importance of achievement of PET-negative status before HDT/ASCT and validates the usefulness of PET-adapted sequential therapy in relapsed or refractory Hodgkin's lymphoma”, write Alison Moskowitz and co-authors.

“Furthermore, the high response rate to brentuximab vedotin in the second-line setting warrants further studies with novel regimens containing brentuximab vedotin to use as part of the first salvage treatment, which could ultimately reduce the need for intensive salvage chemotherapy.”

Umberto Tirelli and Michele Spina, from the National Cancer Institute of Aviano in Italy, agree in an accompanying comment that the results are “promising”, but say these must be validated in large patient populations.

“Future challenges include to improve the rate of remission in first-line therapy through incorporation of brentuximab vedotin into the classic [doxorubicin, bleomycin, vinblastine and dacarbazine] regimen, and to continue to improve the number of patients who achieve complete remission and prolonged progression-free survival for this disease”, they add.

References

Moskowitz AJ, Schöder H, Yahalom J, et al. PET-adapted sequential salvage therapy with brentuximab vedotin followed by augmented ifosamide, carboplatin, and etoposide for patients with relapsed and refractory Hodgkin’s lymphoma: a non-randomised, open-label, single-centre, phase 2 study. Lancet Oncol 2015; Published online 12 February. doi:10.1016/S1470-2045(15)70013-6

Tirelli U, Spina M. PET-adapted salvage therapy in Hodgkin’s lymphoma. Lancet Oncol 2015; Published online 12 February. doi:10.1016/S1470-2045(15)70049-5

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