First-Line Brentuximab Vedotin Combined With Dacarbazine or Nivolumab for Older Patients With Classical Hodgkin Lymphoma

Results of a noncomparative phase 2 study demonstrated safety and promising durable efficacy of brentuximab vedotin (BV)-dacarbazine (DTIC) and BV-nivolumab frontline treatment combinations, which suggest these therapies as potential alternatives for older patients with classical Hodgkin lymphoma who are unfit for initial conventional chemotherapy.

“Older patients with advanced-stage [cHL] have inferior outcomes compared with younger patients, potentially due to comorbidities and frailty,” stated Jonathan W. Friedberg, MD, Wilmot Cancer Institute, University of Rochester, Rochester, New York, and colleagues.

Investigators enrolled patients aged ≥60 years with classical Hodgkin lymphoma who were unfit for conventional chemotherapy to receive frontline BV (1.8 mg/kg) with DTIC (375 mg/m²) (part B) or nivolumab (part D; 3 mg/kg). In these 2 cohorts, 50% and 38% of patients, respectively, had ≥3 general comorbidities or ≥1 significant comorbidity.

Results demonstrated that of the 22 patients who were treated with BV-DTIC, 95% achieved objective response, and 64% achieved complete response (CR). It was noted that the median progression-free survival (mPFS) was 47.2 months; the median overall survival (mOS) was not reached. Of the 21 patients treated with BV-nivolumab, 86% achieved objective response, and 67% achieved CR. With 51.6 months of median follow-up, mDOR, mPFS, and mOS were not reached.

Safety measure reports noted that 10 patients (45%) with BV-DTIC and 16 patients (76%) with BV-nivolumab experienced grade ≥3 treatment-emergent adverse events (AEs); sensory peripheral neuropathy (PN; 27%) and neutropenia (9%) were most common AEs with BV-DTIC, and increased lipase (24%), motor PN (19%), and sensory PN (19%) were the most common in the BV-nivolumab arm.

“Despite high median age, inclusion of patients aged ≤88 years, and frailty, these results demonstrate safety and promising durable efficacy of BV-DTIC and BV-nivolumab combinations as frontline treatment, suggesting potential alternatives for older patients with cHL unfit for initial conventional chemotherapy,” concluded Friedberg and coauthors.

Source:

Friedberg J, Bordoni R, Patel-Donnelly D, et al. Brentuximab vedotin with dacarbazine or nivolumab as frontline cHL therapy for older patients ineligible for chemotherapy. Blood (2024) 143 (9): 786–795. doi: 10.1182/blood.2022019536