Transcript
Dr Evens: A couple last abstracts, we'll shift now to relapsed/refractory Hodgkin lymphoma, and also a couple oral presentations that have occurred here at the ASH 2019 Meeting.
This first one was number 132. It was an oral presentation entitled, "Brentuximab Vedotin in First Relapsed/Refractory Classical Hodgkin Lymphoma Patients Treated By ICE Chemotherapy Before Autologous Transplantation” A phase 2 study. Of course, always hard to find a confirmatory conclusion, but still interesting data.
Dr Friedberg, maybe just a little big picture on relapsed/refractory. How do we incorporate novel agents and how do you do it in your practice?
Dr Friedberg: I think this is a rapidly changing landscape. Historically, the way patients with relapsed and refractory Hodgkin lymphoma were treated were to be given usually a type of salvage chemotherapy regimen. There are a number of them out there. Honestly, all of them came in with about the same response rate.
For patients who had adequate response proceed with high-dose therapy and autologous stem cell transplantation. Beginning several years ago, people began to incorporate these novel agents into salvage regimens in various ways. Sometimes in combination. When drugs like brentuximab vedotin were combined with regimens like ICE, the response rate appeared to go up.
The other way that people were trying to do this is sequentially, where a group of patients may not even had needed the chemotherapy and were able to obtain adequate response with novel agents alone. Again, more recently, as I previously alluded to, there's enthusiasm of combining brentuximab with drugs like nivolumab or pembrolizumab in salvage therapy to try to spare chemotherapy.
I think the general theme is that when you combine with brentuximab, the outcomes are improved. One question is, is that many of us are using brentuximab maintenance after autologous stem cell transplant based on a trial that did not include brentuximab as part of salvage.
The benefit of brentuximab maintenance is not really known when you use brentuximab salvage. I think many of us here are doing that as well.
Dr Evens: Dr Ansell, I know there's still an open cooperative group study, ECOG-ACRIN, that would use a doublet versus a triplet that can include pretransplant. Is that right?
Dr Ansell: That's correct. That's actually using these novel agents together, but adding another novel agent, that's the ipilimumab, the CTLA4-targeted antibody. Again, really just trying to look into how you can improve the outcomes of patients and get more patients to transplant. Tolerable salvage, and then moving into a transplant setting.
Dr Evens: Do you want a patient in a complete remission before you take them to transplant by Deauville PET?
Dr Ansell: There's a lot of discussion and debate about that. I tend to be a little less picky, if you like. My goal is to get as many people to transplant. If you look at all the historic data, actually the outcomes for people in partial remission and even some of the people that didn't have such a great response is still pretty favorable.
I tend to be careful not to overtreat to the point of have to get to CR. As long as you had a good response, I think that's satisfactory in my book. The only thing I would say that is interesting to me is our big focus on salvage treatment that is not chemotherapy. Yet, we're about to give them a monster dose of chemotherapy.
We used to say chemo sensitivity was important to determine if more chemotherapy was better. Actually, this is, as Jonathan was saying, a very rapidly changing field to understand. When we don't use chemo in the beginning and then give it afterwards, do we still get the same results?
Dr Evens: Dr Vose, how about in your practice? Let's say off a clinical trial, are you starting to incorporate novel therapeutic agents? First relapse?
Dr Vose: Yeah, first relapse. Unfortunately, based upon insurance issues, sometimes we're not able to do that. Definitely, I've participated in many of these trials and have had great responses in these patients. When it's available, I definitely would like to incorporate specifically brentuximab into the salvage therapy as possible.
Dr Evens: Great.
