Brentuximab Vedotin With Dacarbazine or Nivolumab Is Viable Option for Older Patients With cHL Ineligible for Chemotherapy

Patients with classic Hodgkin lymphoma (cHL) who are unfit to receive conventional chemotherapy can receive brentuximab vedotin (BV) with dacarbazine or nivolumab as viable alternatives to first-line therapy, according to a study published in Blood. 

Chemotherapy is typically the first-line treatment in cHL; however, in patients who are unable to tolerate this therapy, physicians are increasingly turning to second-line therapeutic candidates such as BV and dacarbazine. 

“A sequential therapy approach of single-agent BV, followed by chemotherapy, followed by BV maintenance therapy demonstrated favorable outcomes in patients who could complete the regimen,” the investigators wrote in their report.

There is considerable evidence suggesting that BV monotherapy or prescribed in combination with dacarbazine yield significant response rates. The authors of the study sought to evaluate long-term follow-up data among patients who have been prescribed BV-dacarbazine therapy among older individuals with untreated cHL. 

This study was divided into 2 cohorts: those receiving BV monotherapy or in combination with dacarbazine/nivolumab. Patients were recruited if they were 60 years of age or over with a histologically confirmed diagnosis of cHL. The primary endpoint was objective response rate. In addition, imaging studies were conducted throughout the trial, allowing disease status to be evaluated via computed tomography (CT) at various points of the study. 

For patients who were given BV monotherapy as second-line treatment, the treatment response rate was 92%, with complete remission indicated in 73% of individuals. In the BV-dacarbazine combination, there was a mean progression-free survival period of 47.2 months. This supports “the inference that some patients treated with this regimen may go on to be cured, and this regimen is currently endorsed as a treatment option for older patients with advanced-stage Hodgkin lymphoma by established guidelines,” the authors of the report explained. 

The researchers also explored the use of BV with nivolumab. They reported that this combination therapy has an acceptable safety profile and demonstrates promising efficacy in older individuals with cHL who have significant comorbidities, with durable responses achieved across participants. 

“If our results are validated in larger studies, a future precision approach to the treatment of older patients with cHL may include baseline geriatric assessment, with fit patients receiving chemotherapy-based approaches similar to younger patients and unfit/frail patients receiving the BV-nivolumab regimen, given our observed durable [complete responses] in a subset of these patients,” the authors of the study concluded. 

Reference 

Friedberg JW, Bordoni RE, Patel-Donnelly D, et al. Brentuximab vedotin with dacarbazine or nivolumab as frontline cHL therapy in older patients ineligible for chemotherapy. Blood. Published online November 9, 2023. doi:10.1182/blood.2022019536

This article originally appeared on Hematology Advisor