Importance of Clinical Trials for Treatment Data in Hodgkin Lymphoma Research

At the 2024 Great Debates & Updates (GDU) in Hematologic Malignancies meeting in New York, Andrew Evens, DO, MBA, MSc, Rutgers Cancer Institute of New Jersey, New Jersey, emphasizes the importance of continuing clinical trials for patients with Hodgkin lymphoma to gather valuable treatment data.

Transcript:

Dr Evens: Hi, my name is Dr Andy Evens. I am at the Rutgers Cancer Institute of New Jersey. I'm the Deputy Director for Clinical Services and Medical Director for the RWJBarnabas Health Oncology Service Line. I was happy to speak at today's [Great Debates and Updates in Hematologic Malignancies] conference on the topic of Hodgkin lymphoma.

Lymphoma, Leukemia & Myeloma Network: When would hematologists recommend a patient with Hodgkin lymphoma to enroll in a clinical trial? If this is the correct treatment path, what would the process look like?

Dr Evens: In terms of clinical trials and Hodgkin lymphoma, asked sometimes by some [is the question], "Why do you need to keep studying Hodgkin Lymphoma? Isn't the cure rate 85 to 90%?" Generally, yes, that is true at 3 and 5 years. Yes, we've made significant progress, obviously starting in the 1960s and going through with combination chemotherapy and the novel targeted therapeutic agents. There are several important reasons why clinical trials remain critically important for Hodgkin lymphoma.

Number 1, these are mostly younger patients. The majority of patients are in their 20s and 30s. So, even though there is a relatively high bar at 3 years [and] 5 years in terms of progression-free survival, we know even in the contemporary era, meaning right now, there are post-acute and late effects.

When I say post-acute, that means within a year, up to 10 years of finishing therapy. Because we often hear, “Well, late effects, that's decades later.” Yes, there are risks decades later, but there have been some important analyses looking at over 20,000 Hodgkin lymphoma survivors. When they looked at that database at only 8-year follow-up, at 1 year, you start seeing increased excess mortality of non-Hodgkin causes in Hodgkin lymphoma survivors, including ones who only receive chemotherapy. Heart disease, infections, lung disease, [and] other issues, it's something we know. We need to have the long lens when we're thinking about clinical research.

The way we're going to do that, of course, is more individualized therapy and a continued decrease [in] reliance on combination chemotherapy and radiation therapy. Of course, that still is the mainstay, chemotherapy now, in particular, anthracycline. But we want to continue to incorporate novel-targeted therapeutics. What's the least amount available and the most targeted available to cure patients so they can not only enjoy that 3- to 5-year survival, but hopefully mitigate, if not eliminate, post-acute and late effects?

And then, of course, there are other patient populations, number 2, such as older patients, even though most are younger, 20% are over age 60 years old in Hodgkin lymphoma. And those have, over the last 20 years, have had very disproportionate survival rates, like 40 [to] 50 percentage points worse. I think we've closed that gap over the last few years, partly through novel, targeted therapeutic agents, but that's a really critical unmet need. And when I say older patients, we don't want to say one size fits all. There [are] some really fit patients, and then there [are] some unfit, if not frail patients.

We just need more data. Not just prognostication, but obviously, therapeutic data of what's the right treatment at the right time for the right patient based on their characteristics and their lymphoma. So, all of these are very important. Of course, the cost of care is another thing we don't want to forget about, but clinical trials still remain very important in Hodgkin lymphoma. And thankfully, there are still national clinical trials enrolling in this field.

Source:

Evens A. Reevaluating Frontline Therapy and Beyond for Hodgkin Lymphoma: Strategies for Optimal Clinical Decision-Making and Targeted Therapy Across Patient Groups. Presented at the 2024 Great Debates & Updates in Hematological Malignancies: April 5-6, 2024. New York City, NY.