Transcript
Dr Evens: One last one that will wrap this up. Another interesting longer term because, of course, these are good-to-see early results, but you want to see are they holding up and are there late relapses, etc.
This is abstract number 238 entitled, "Brentuximab Vedotin and Nivolumab for Relapsed or Refractory Classical Hodgkin Lymphoma: Long-Term Follow-Up of Results from the Single Phase 1/2 Study." I know many of you at the table here participated in this.
Let's start maybe at the end, Dr Ansell, this study and how do we interpret it. Obviously, it's going to change, like we said, as agents move up further. Let's assume brentuximab vedotin, nivolumab-naïve patient in these results.
Dr Ansell: I think our traditional approach has been to use a chemotherapy backbone. ICE chemotherapy would be an example. About 60, 70% of patients may benefit from that and be able to go on to transplant. These results are stellar in comparison, where with a targeted and a novel therapy approach, you're getting very high response rates and a high percentage of patients going to transplant.
I think that really makes these data extremely compelling. I think as we discussed earlier, the question of utilizing this combination followed by brentuximab vedotin maintenance thereafter is still not well-studied. I do think that this is a regimen that has shown real promise and well-tolerated with a very high response rate and a high number of people going to transplant.
Dr Evens: Great. Dr Friedberg, if you had a patient, let's say, relapsed after an autologous transplant and whether on study like this or off study responding, how long do you keep them on therapy?
Dr Friedberg: I think that's a question we don't know the answer to as far as data really guiding us. In my experience, it's challenging to keep a patient on brentuximab for a very prolonged period of time just due to cumulative toxicity.
If I were using this combination, I would generally plan on about a year of therapy with a relatively low threshold to curtail brentuximab or lower the dose if any toxicity developed.
I think one interesting question that this study raises given the stellar results is how important is autologous transplant for a subset of these patients, and whether this combination may be given for a slightly prolonged period of time, maybe sufficient at curing patients.
I would not advocate avoiding transplant outside of a clinical trial. I think it may be time to consider clinical trials that begin to address that question in this era.
Dr Evens: At least for low-risk patients like relapsed, etc.
Dr Friedberg: Who obtained a rapid CR. You have regimens like this that seem to do, in a subset of patients, provide durable responses.
Dr Evens: Last but not least, Dr Vose, I want to ask you about allogeneic transplant. It's maybe gone lower on our totem pole of treatment options with these novel therapeutic agents. I know there's some data, it's going to be presented later today by the Dana-Farber, Dr. Merryman.
Especially in a post-transplant side world, how do you think about that? Are you still recommending that for select patients, allotransplant, or really keeping it low on the totem pole?
Dr Vose: Honestly, there's so many other options now for most patients, including the things we've talked about today, but also including potentially CAR T-cell trials, CD30, and many other options. I don't recommend allotransplant anymore, except for the very, very uncommon young patient where they've relapsed after all these options we've talked about. It's really low in my totem pole for options.
Dr Evens: Does everyone agree? Is that pretty much with the novel?
Dr Friedberg: Despite the fact, most of these patients are young. Historically, in every study, that's been done. Allogeneic transplant has had marked toxicity in this group of patients.
Transplant-related mortality is disproportionately high for Hodgkin lymphoma. Some people would say it's because they're heavily pretreated or maybe because they're immunosuppressed. I'm not sure that in this era that's changing. I totally agree with what Julie had to say.
Dr Evens: Dr Ansell, last word?
Dr Ansell: I would say it's not entirely gone away. The reason is just we, unfortunately, are still seeing people fail after PD1 blockade. Even though we do have some other therapies and we do have CAR T-cells coming, unfortunately, there's still a subset of patients where they're progressing.
Is allo their best choice? There are lots of challenges related to that. It's not gone entirely, because when you do get a patient in a complete remission, that is a question that pops back into your head about, "Should we consider this?" I think it needs to at least be discussed, but it has lots of challenges.
Dr Evens: Fantastic. I'd really like to thank our 3 Hodgkin lymphoma experts and Oncology Network for putting this together at 2019 ASH Meeting. Thank you very much. Thank you.
Dr Ansell: Thank you.
