Recently published results of a phase II clinical trial have shown the best outcomes to date for newly diagnosed older Hodgkin lymphoma patients treated with brentuximab vedotin given before and after doxorubicin, vinblastine and dacarbazine (AVD) chemotherapy, which is the standard of care.
Causes of poor outcomes for older Hodgkin lymphoma patients are not well understood although inability to tolerate full doses of chemotherapy, the existence of co-morbidities, disease biology, and other factors have often been attributed.
The aim of this multicenter, investigator-initiated study was to improve outcomes for this difficult to treat population. Results of the work were published in the September 4 online edition of the Journal of Clinical Oncology (doi: 10.1200/JCO.2018.79.0139).
In this study, participants who were initially untreated for their disease received two ‘lead-in’ doses of single-agent brentuximab vedotin, which were followed by six cycles of standard AVD chemotherapy. Responding subsequently patients received four brentuximab vedotin consolidation cycles. Enrolled were 48 patients with a median age of 69; 82 percent had advanced stage disease and 60 percent had high-grade co-morbidities.
The overall response rate to the initial brentuximab vedotin lead-in dose was 82 percent with a complete remission rate of 36 percent. After first-line chemotherapy was administered, the overall response rate and remission rates were 95 percent and 90 percent, respectively.
Additionally, the two-year progression-free survival rate was 84 percent with an associated overall survival rate of 93 percent on intent-to-treat analyses. In addition, baseline assessment of geriatric measures including activities of daily living and presence of co-morbidities was strongly prognostic for patient outcome in this study.
The authors said study limitations include the inability of some patients to complete therapy as planned (23 percent did not receive the prescribed six AVD cycles; 48 percent did not complete brentuximab vedotin consolidation cycles). Strategies to decrease the length of the therapy, either through individual drugs or number of cycles administered, should also be explored.
The research was funded as an investigator-initiated clinical trial via Seattle Genetics. An earlier version of the work was presented at the December 2017 American Society of Hematology Annual Meeting; and in part at the 10th International Symposium on Hodgkin Lymphoma in October 2016 in Cologne, Germany. Additional details including information on conflicts of interest can be found at: doi: 10.1200/JCO.2018.79.0139.
