887MO - Real-world treatment management of patients with advanced-stage classic Hodgkin lymphoma receiving front line therapy

Background

Despite the therapeutic success in the management of Hodgkin lymphoma (HL), customization of therapy requires skillful decisions taking into consideration the risk of adverse events (AEs), even among subpopulations treated with low intensity regimens. This study aims to evaluate the usage of PET-adapted strategies and the management of AEs in cHL patients receiving front line therapies in Italy (IT), Spain (SP), and Israel (IL).

Methods

At 28 sites in IT, SP and IL, medical records were abstracted for patients diagnosed between March 2014 and August 2018 with advanced cHL and treated with conventional 1L systemic therapies.

Results

The aggregate sample (N=256) comprised of patients with advanced- stage cHL, treated in 1L with ABVD (86.3%), AVD (2.7%), BEACOPPinitiation-based (8.6%), or other systemic therapy (2.3%), and distributed across IT (35.5%), SP (41.3%), and IL (23.2%). Median (range) age at initial cHL diagnosis was 39 (19 – 91), males- 54.3%. Among 221 patients who received 1L ABVD (the most prevalent regimen type), 187 (84.6%) patients completed six cycles of therapy, 142 (66.6%) underwent interim PET2, of which 30.4% were positive, however few (n= 25, 17.6%) had PET-adapted modifications. A majority (89.1%) of patients received at least one supportive care product. AEs were more prevalent among older patients (>60 years). All grade neutropenia occurred in 47.1% of the patients receiving ABVD; the rate of febrile neutropenia was 6.8%. Other AEs included: infections (22.2%), anemia (27.6%), thrombocytopenia (2.7%). Cardiovascular or pulmonary complications occurred in 5 (2.3%) and 22 (10%) ABVD patients, respectively, 11 of whom had undergone PET2 assessment - 3 with treatment de-escalation.

Conclusions

Unmet needs exist with respect to the balance between therapeutic efficacy and safety risks of 1L chemotherapies in cHL. Even when PET2 scans are available to monitor tumour response, they are not always used to modify treatment management. Most patients continue to rely on supportive care products, or experience avoidable toxicities, underscoring the importance of new treatment combinations with novel agents.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Takeda Pharmaceuticals International AG.

Funding

Takeda Pharmaceutical International AG.

Disclosure

A. Avigdor: Advisory/Consultancy: Takeda; Advisory/Consultancy, Research grant/Funding (institution): Janssen; Advisory/Consultancy: Roche. F. Trinchese, F. Gavini, N. Bent-Ennakhil, A. Zomas: Full/Part-time employment: Takeda. M. Dalal: Full/Part-time employment, Stock ownership: Millennium Pharmaceuticals, Inc. G. Gini: Advisory/Consultancy: Takeda. All other authors have declared no conflicts of interest.