Addition of Pembrolizumab to Ifosfamide, Carboplatin, and Etoposide Chemotherapy Among Patients With R/R Classic Hodgkin Lymphoma

Results from a Phase 2 Single-Group Trial

The addition of pembrolizumab to ifosfamide, carboplatin, and etoposide (ICE) chemotherapy yielded safe and tolerable results among patients with relapsed/refractory (R/R) classic Hodgkin lymphoma, according to findings from a phase 2, single-group trial recently published in JAMA Oncology. 

Locke J. Bryan, MD, Division of Hematology and Oncology, Georgia Cancer Center at Augusta University, Augusta, Georgia, and coauthors aimed to measure a primary endpoint of complete response rate after salvage therapy, as defined as a Deauville score of ≤3, as well as secondary endpoints including progression-free survival, overall survival, stem cell mobilization, neutrophil and platelet engraftment, and safety. 

42 patients with a median age of 34 years who had biopsy-proven R/R classic Hodgkin lymphoma and had undergone 1 or 2 prior lines of therapy were enrolled in this study. All patients had measurable lesions detected by FDG-PET/CT and were eligible for transplant. 

On day 1, patients were administered 2 cycles of pembrolizumab at 200 mg. Every 21 days, they were given ICE chemotherapy followed by stem cell mobilization and collection, as well as 1 cycle of pembrolizumab monotherapy. Finally, patients received an FDG-PET/CT lesion assessment.

Results indicated that the complete response rate for the 37 patients eligible for FDG-PET/CT lesion assessment was 86.5%, and the overall response rate was 97.3% (n=36). 10.8% of this group of patients reached partial response (n=4). There was no difference in stem cell mobilization, collection, or engraftment following the addition of pembrolizumab. 2-year estimates of progression-free survival and overall survival were 87.2%, respectfully. In terms of safety, 1 patient had a noncaseating granuloma and 1 patient had a reactive lymph node. 

As all endpoints were met Dr Bryan et al concluded, “the addition of pembrolizumab to ICE chemotherapy was well tolerated and highly effective in comparison with prior reports of chemotherapy-only regimens, supporting further investigation in patients with relapsed or refractory classic Hodgkin lymphoma eligible for an autologous stem cell transplant.”

Source: 

Bryan LJ, Casulo C, Allen PB, et al. Pembrolizumab added to ifosfamide, carboplatin, and etoposide chemotherapy for relapsed or refractory classic hodgkin lymphoma. JAMA Oncology. Published online March 16, 2023. doi:https://doi.org/10.1001/jamaoncol.2022.7975