Outcomes for patients with Hodgkin lymphoma continue to improve, thanks to new drugs, according to Dr. Pamela Allen.
The outcomes of patients with classical Hodgkin lymphoma have improved in recent decades, as the disease represents only about 0.2% of all cancer-related deaths in the United States. Now, as more promising treatment regimens enter the market, patients with the disease will continue to see better prognoses.
“Hodgkin’s is really one of the major success stories, not just in lymphoma, but across all malignancies. Death rate related to Hodgkin’s has been steadily declining since the 1970s,” said Dr. Pamela Allen, assistant professor at the Winship Cancer Institute of Emory University.
Allen recently discussed treatment updates for Hodgkin lymphoma at the CURE® Educated Patient Leukemia & Lymphoma Summit.
Early-stage, favorable Hodgkin lymphoma was traditionally treated upfront with a combination regimen consisting of Adriamycin (doxorubicin), Blenoxane (bleomycin), Vinblastine (Alkaban-AQ), and dacarbazine (DTIC-Dome), commonly referred to as ABVD. After ABVD treatment, patients who have a complete response will undergo radiation or more ABVD.
If patients still have residual disease after ABVD treatment, they will typically get more ABVD plus radiation therapy, while patients who have progressive disease after initial treatment will have escalated BEACOPP chemotherapy or high-dose chemotherapy and transplant.
There have been, according to Allen, three exciting Food and Drug Administration (FDA) approvals in the Hodgkin lymphoma space over the last decade: Adcetris (brentuximab vedotin), Opdivo (nivolumab) and Keytruda (pembrolizumab).
“Now all of these agents are approved in the frontline setting,” Allen explained. “Initially, they were approved in the relapsed setting.”
Adcetris plus AVD first gained FDA approval for Hodgkin lymphoma in 2011, after it had a 75% response rate in patients with relapsed disease.
The drug, an antibody drug conjugate, works by attaching to chemotherapy and then targeting cells expressing CD30, a tumor marker commonly found in Hodgkin lymphoma. After positive findings in the relapse setting, the drug was moved up and is now standard of care for patients with advanced disease.
Opdivo plus AVD was approved by the FDA in 2016, after results from the CheckMate205 trial showed that the drug combination elicited a 93% response rate in patients with newly diagnosed, untreated classical Hodgkin lymphoma that was stage 2b, 3 or 4.
The next year, another checkpoint inhibitor, Keytruda, was approved for relapsed/refractory Hodgkin lymphoma.
In a small study at the Winship Cancer Institute, Allen and her colleagues investigated the effectiveness of the following sequencing of treatments for newly diagnosed, early, unfavorable and advanced stage classical Hodgkin lymphoma: three rounds of Keytruda, two rounds of AVD, then two to four rounds of AVD.
“You really can’t ask for better results than this,” Allen said. “We had 100% progression-free and overall survival, and every patient had remission.”
While these approvals are exciting, there are still advancements on the horizon for this patient population – from targeted therapies and novel combinations to CAR-T-cell therapy, which are being studied in cancer centers around the globe.
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