Ann Lacasce MD, MMSc, of Dana-Farber Cancer Institute presented findings at #ASH24 suggesting treatment with brentuximab vedotin and nivolumab can reduce toxicities and may decrease the need for radiation in early stage high-risk cHL patients.
Outcomes for patients with early stage classic Hodgkin lymphoma are generally excellent. Historically, patients have been treated with a combination of chemotherapy followed by radiation, which can be associated with significantly toxicities, particularly related to radiotherapy uh in this patient population, which is enriched for young adults. So in this study, we incorporated the novel agents rituximab, Vidotin and volumab into uh the treatment of patients with early stage Hodgkin lymphoma in hope of in hopes of improving outcomes and avoiding radiation. 153 patients were enrolled after receiving two cycles of ABVD chemotherapy. Those who were PET 2 negative and had non-bulky disease, uh, defined as a mediastinal mass of less than 7.5 centimeters, were randomly assigned to 3 cycles of rituximab plus navolumab versus 2 additional cycles of ABVD followed by 6 doses of navolumab. Patients who had bulky disease and were PET 2 negative received 2 cycles of ABDD followed by navolumab. The patients who were PET 2 positive received 4 cycles of rituximab plus AVD. Those patients who then had a negative PET scan went on to receive 6 doses of nivolumab. Overall, this was a relatively high risk population of patients with early stage Hodgkin lymphoma, with a 30% having stage 2B disease and a third of patients having a bulky disease. Overall, the therapy was generally well tolerated in terms of outcomes for those patients who were PET 2 negative and had Uh, non-bulky disease, there were no recurrences, uh, with a two-year progression free survival of 100%. For patients who were PET 2 negative and had bulky disease, 86% of patients were progression-free at 2 years. The patients who are PET 2 positive, however, uh, had a little bit lower rates of disease control, 77% at two years. So overall, we think that this study very much supports the incorporation of these novel agents into the therapy of early stage classic Hodgkin lymphoma, uh, for patients who are PET2 positive. Uh, uh, alternative approaches are likely needed, and those patients probably do require some radiation. Uh, this study, uh, supports an ongoing, uh, US intergroup study led by the Children's Oncology Group studying uh branttuximab plus nivolumab versus standard of care and early stage classic Hodgkin lymphoma.
