Transcript
Dr. Evens: Let's move on to another frontline presentation. This was one that's in older patients, newly diagnosed with Hodgkin lymphoma. It was abstract number 237, also an oral presentation on Saturday. That was entitled, "Phase 2 Study of Frontline Brentuximab Vedotin Plus Nivolumab in Patients with Hodgkin Lymphoma Aged 60 years or Older."
Dr. Friedberg was the senior author on that. Can you talk about this patient population, maybe 50,000-foot how you assess it, where this study fit in, and some of the key results?
Dr. Friedberg: Somewhere between 15 and 20% of patients with Hodgkin lymphoma are over the age of 60 years. We know that particularly patients over the age of 70 years have a markedly inferior prognosis. They have not enjoyed the high cure rates that we've seen. That might be due in part to unique biology, but it's certainly due to inability to tolerate standard therapy.
Even regimens like ABVD, once patients are over the age of 70, can be a real challenge due to toxicity. In a group that involves several institutions, beginning several years ago, we began to look at brentuximab-containing regimens as an alternative to chemotherapy for these older patients.
I should emphasize that the median age in all of these studies is around 74. Many of the patients exceed age 80. Many of the patients have multiple comorbidities as scored by geriatric assessment. The initial study was brentuximab alone. Then we combined brentuximab and dacarbazine, and showed that it seemed to provide improved PFS.
We tried to combine brentuximab and bendamustine, but for this group of patients, that was found to be too toxic. This current abstract was our fourth iteration where we were combining brentuximab and nivolumab. I think people are aware that in the relapse setting, this looks very promising as a salvage regimen. There's a lot of experience using checkpoint blockade in older patients.
We were excited about this combination. What we demonstrated in very early follow-up was a very high response rate. Almost all patients responded to the treatment. There was a high complete response rate. Thus far, 2 of the patients who obtained complete responses have progressed.
It's a little bit early to assess whether this regimen looks better than the brentuximab and dacarbazine regimen. From a tolerability standpoint, the dose intensity that was given was very high on this study. The median number of cycles that were given were 10 cycles of treatment, suggesting that the patients really tolerated it well.
I think that for those significantly older patients, or for patients that have a number of comorbidities, this type of approach is an approach really that should be considered rather than chemotherapy.
Dr. Evens: Dr. Ansell, that seems may be more of the unfit or even frail patient population. What about the more fit patient? Are you still thinking of anthracycline-based therapy in these patients?
Dr. Ansell: Yes. That's a good question. Again, as Jonathan pointed out, one of the challenges is just we want to see people cured. We'd love to see that translate into the elderly. I think we do need a little bit further follow-up on that trial because there are some patients trickling down. There's an accrued study that also had a little less than perfect results with patients progressing.
I think it's a very effective therapy, but the durability is going to be the challenge. That's to your question about have anthracyclines dropped out of the regimen, because cure is still our focus. I think in patients that can tolerate that; they need to still continue to receive an anthracycline-based regimen because that's where the curative results are.
We'd love to see, as new agents get incorporated, that we can drop more and more of the traditional chemotherapy out. We want to be careful not to drop it too fast so that we actually lose the curative results that we've had in the past.
Dr. Evens: That's great. It's just fantastic that this patient population somewhat have a renewed resurgence. Maybe it's because we have new drugs targeted is being studied. Number 1 and number 2, great that we're interacting with our geriatric oncology colleagues. Hopefully, more to come on that.
