A combined chemotherapy approach may eliminate the toxic effects of radiation therapy in children and young adults with Hodgkin lymphoma, according to early results of a study that will be presented at the 2017 ASCO Annual Meeting (June 2-6, 2017; Chicago, IL).
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Survival rates are high for children and young adults diagnosed with Hodgkin lymphoma. However, the standard of care regimen involving radiation therapy tends to result in significant – and sometimes life-threatening – toxicities. The CD30-targeting antibody-drug conjugate brentuximab vedotin, as well as the chemotherapy agent rituximab, have shown efficacy in relapsed disease.
Jessica Hochberg, MD, New York Medical College (Valhalla, NY), and colleagues conducted a study to assess the addition of brentuximab vedotin and rituximab to combination chemotherapy for safety, preservation of event-free survival, and elimination of radiation-induced toxicity in children and young adults with newly diagnosed Hodgkin lymphoma. A total of 19 patients (aged 4-23 years; median age, 15 years) underwent 3 to 6 cycles of chemoimmunotherapy. Low-risk patients (n = 2) were treated with brentuximab vedotin with doxorubicin, vincristine, prednisone and darcarbazine. Intermediate-risk patients (n = 13) and high-risk patients (n = 4) were treated with doxorubicin, vinblastine, darcarbazine and rituximab.
Early responses were measured by positron emission tomography (PET) or computed tomography (CT) scans after 2 cycles. Patients who responded slowly to treatment received an additional 2 cycles of therapy. Radiation therapy was to be administered in the event of a partial or non-response.
Among the 17 patients who have completed therapy, all of them (100%) have achieved a complete response. Eleven (58%) achieved a rapid early response. The event-free survival and overall survival among these patients was 100% after a median follow-up of 30 months. No patient required radiation therapy.
Toxic events reported from the study were grade 3 mucositis (n = 1) and grade 3 infusion reaction to brentuximab (n = 1).
Authors of the study concluded that the addition of brentuximab vedotin and rituximab to combination chemotherapy appears to maintain efficacy of standard of care therapy while reducing toxic effects. Additional follow-up and a larger cohort are needed to determine long-term outcomes of this treatment approach.—Zachary Bessette
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