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Schroers-Martin JG, Advani R. Integrating Novel Agents Into the Clinical Management of Classic Hodgkin Lymphoma. JCO Oncol Pract 2024:OP2400277. [PMID: 39265129 DOI: 10.1200/op.24.00277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 07/11/2024] [Accepted: 08/08/2024] [Indexed: 09/14/2024] Open
Abstract
Classic Hodgkin lymphoma (cHL) is highly curable at all stages. Research efforts over the past few decades have largely focused on interim PET-adapted strategies for therapy de-escalation or intensification. The overarching goals have been to increase cure rates, minimize potential therapy-related effects, and optimize survivorship. Better understanding of the biology of cHL has led to the development and approval of effective novel agents including the antibody-drug conjugate brentuximab vedotin and the checkpoint inhibitor immunotherapies. In this review, we discuss recent trial results and how these agents are integrated into clinical practice with the goal of further optimizing outcomes.
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Affiliation(s)
| | - Ranjana Advani
- Department of Medicine, Division of Oncology, Stanford University Medical Center, Stanford, CA
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2
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Abramson JS, Stuver R, Herrera A, Patterson E, Wen YP, Moskowitz A. Management of peripheral neuropathy associated with brentuximab vedotin in the frontline treatment of classical Hodgkin lymphoma. Crit Rev Oncol Hematol 2024; 204:104499. [PMID: 39244180 DOI: 10.1016/j.critrevonc.2024.104499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 08/29/2024] [Accepted: 08/30/2024] [Indexed: 09/09/2024] Open
Abstract
The ECHELON-1 trial demonstrated the effectiveness of brentuximab vedotin (BV) in combination with doxorubicin, vinblastine, and dacarbazine as a frontline treatment regimen in classical Hodgkin lymphoma. However, peripheral neuropathy (PN) is common with this regimen, occurring in up to two-thirds of patients. While standard prescribing information recommends BV dose modification at the onset of grade 2 PN, management strategies for PN are not well-defined. Most commonly, clinicians dose reduce or discontinue BV, vinblastine, or both. We review evidence-based and practical approaches for managing peripheral neuropathy, emphasizing early detection and dose modification.
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Affiliation(s)
| | - Robert Stuver
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | | | | | - Alison Moskowitz
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
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3
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Benevolo Savelli C, Bisio M, Legato L, Fasano F, Santambrogio E, Nicolosi M, Morra D, Boccomini C, Freilone R, Botto B, Novo M. Advances in Hodgkin Lymphoma Treatment: From Molecular Biology to Clinical Practice. Cancers (Basel) 2024; 16:1830. [PMID: 38791909 PMCID: PMC11120540 DOI: 10.3390/cancers16101830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/05/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Classical Hodgkin Lymphoma (cHL) is a highly curable disease, but around 20% of patients experience progression or relapse after standard frontline chemotherapy regimens. Salvage regimens followed by autologous stem cell transplants represent the historical treatment approach for these cases. In the last decade, with the increasing understanding of cHL biology and tumor microenvironment role in disease course, novel molecules have been introduced in clinical practice, improving outcomes in the relapsed/refractory setting. The anti-CD30 antibody-drug conjugated brentuximab vedotin and PD-1/PD-L1 checkpoint inhibitors represent nowadays curative options for chemorefractory patients, and randomized trials recently demonstrated their efficacy in frontline immune-chemo-combined modalities. Several drugs able to modulate the patients' T-lymphocytes and NK cell activity are under development, as well as many anti-CD30 chimeric antigen receptor T-cell products. Multiple tumor aberrant epigenetic mechanisms are being investigated as targets for antineoplastic compounds such as histone deacetylase inhibitors and hypomethylating agents. Moreover, JAK2 inhibition combined with anti-PD1 blockade revealed a potential complementary therapeutic pathway in cHL. In this review, we will summarize recent findings on cHL biology and novel treatment options clinically available, as well as promising future perspectives in the field.
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Affiliation(s)
- Corrado Benevolo Savelli
- Hematology Division, A.O.U. Città della Salute e della Scienza di Torino, C.so Bramante 88, 10126 Turin, Italy; (M.B.); (L.L.); (F.F.); (E.S.); (M.N.); (D.M.); (C.B.); (R.F.); (B.B.)
| | | | | | | | | | | | | | | | | | | | - Mattia Novo
- Hematology Division, A.O.U. Città della Salute e della Scienza di Torino, C.so Bramante 88, 10126 Turin, Italy; (M.B.); (L.L.); (F.F.); (E.S.); (M.N.); (D.M.); (C.B.); (R.F.); (B.B.)
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4
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Friedberg JW, Bordoni R, Patel-Donnelly D, Larson T, Goldschmidt J, Boccia R, Cline VJM, Mamidipalli A, Liu J, Akyol A, Yasenchak CA. Brentuximab vedotin with dacarbazine or nivolumab as frontline cHL therapy for older patients ineligible for chemotherapy. Blood 2024; 143:786-795. [PMID: 37946283 DOI: 10.1182/blood.2022019536] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 09/29/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023] Open
Abstract
ABSTRACT Older patients with advanced-stage classical Hodgkin lymphoma (cHL) have inferior outcomes compared with younger patients, potentially due to comorbidities and frailty. This noncomparative phase 2 study enrolled patients aged ≥60 years with cHL unfit for conventional chemotherapy to receive frontline brentuximab vedotin (BV; 1.8 mg/kg) with dacarbazine (DTIC; 375 mg/m2) (part B) or nivolumab (part D; 3 mg/kg). In parts B and D, 50% and 38% of patients, respectively, had ≥3 general comorbidities or ≥1 significant comorbidity. Of the 22 patients treated with BV-DTIC, 95% achieved objective response, and 64% achieved complete response (CR). With a median follow-up of 63.6 months, median duration of response (mDOR) was 46.0 months. Median progression-free survival (mPFS) was 47.2 months; median overall survival (mOS) was not reached. Of 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. Ten patients (45%) with BV-DTIC and 16 patients (76%) with BV-nivolumab experienced grade ≥3 treatment-emergent adverse events; sensory peripheral neuropathy (PN; 27%) and neutropenia (9%) were most common with BV-DTIC, and increased lipase (24%), motor PN (19%), and sensory PN (19%) were most common with BV-nivolumab. 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. This trial was registered at www.clinicaltrials.gov as #NCT01716806.
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Affiliation(s)
| | | | | | | | | | - Ralph Boccia
- Center for Cancer and Blood Disorders, Bethesda, MD
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5
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Rached L, Geraud A, Frelaut M, Ap Thomas Z, Goldschmidt V, Beraud-Chaulet G, Nagera-Lazarovici C, Danlos FX, Henon C, Parisi C, Gazzah A, Bahleda R, Postel Vinay S, Smolenschi C, Hollebecque A, Michot JM, Ribrag V, Loriot Y, Champiat S, Ouali K, Massard C, Ponce Aix S, Bringuier M, Baldini C. Antibody drug conjugates in older patients: State of the art. Crit Rev Oncol Hematol 2024; 193:104212. [PMID: 38007063 DOI: 10.1016/j.critrevonc.2023.104212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/16/2023] [Indexed: 11/27/2023] Open
Abstract
More than half of cancer cases occur in patients aged 65 years or older. The efficacy and safety of antibody drug conjugates (ADCs) in older patients remains an unclear subject as available evidence is limited. Geriatric population is underrepresented in clinical trials. Consequently, most of our knowledge regarding innovative therapeutics was studied on a younger population. In this review of published literature, we report the available information on efficacy, safety and pharmacokinetics of FDA approved ADCs for hematologic malignancies and solid tumors in the geriatric population. We explore the results of clinical trials dedicated for older individuals as well as subgroup analyses of the geriatric population in major trials evaluating these drugs. Available data suggest a similar efficacy in older adults as compared to general population. However, older patients might be prone to a higher rate of adverse events in incidence with a potential impact on quality of life. We lack data to support primary dose reductions or schedule modifications in this category of patients. No pharmacokinetic differences were reported between age groups. It is crucial to encourage the development of clinical trials dedicated to older patients with geriatric parameters (G8 score, G-CODE…) so that results can be more representative of this population outside of clinical trials.
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Affiliation(s)
- Layal Rached
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Arthur Geraud
- Gustave Roussy, Department of Medical Oncology , 94805 Villejuif, France.
| | - Maxime Frelaut
- Gustave Roussy, Department of Medical Oncology , 94805 Villejuif, France.
| | - Zoe Ap Thomas
- Gustave Roussy, Department of Medical Oncology , 94805 Villejuif, France.
| | - Vincent Goldschmidt
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | | | | | - Francois-Xavier Danlos
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Clemence Henon
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Claudia Parisi
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Anas Gazzah
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Rastilav Bahleda
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Sophie Postel Vinay
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Cristina Smolenschi
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Antoine Hollebecque
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Jean-Marie Michot
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Vincent Ribrag
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Yohann Loriot
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Stephane Champiat
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Kaissa Ouali
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Christophe Massard
- Centre Eugène Marquis, Department of Medical Oncology, 35000 Rennes, France.
| | - Santiago Ponce Aix
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Michael Bringuier
- Institut Curie, PSL Research University, Department of Medical Oncology and Department of Supportive Care, UCOG Paris Ouest, F-92210 Saint-Cloud, France.
| | - Capucine Baldini
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
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6
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Evens AM. Hodgkin lymphoma treatment for older persons in the modern era. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:483-499. [PMID: 38066840 PMCID: PMC10727079 DOI: 10.1182/hematology.2023000449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
There has been a renewed effort globally in the study of older Hodgkin lymphoma (HL) patients, generating a multitude of new data. For prognostication, advancing age, comorbidities, altered functional status, Hispanic ethnicity, and lack of dose intensity (especially without anthracycline) portend inferior survival. Geriatric assessments (GA), including activities of daily living (ADL) and comorbidities, should be objectively measured in all patients. In addition, proactive multidisciplinary medical management is recommended (eg, geriatrics, cardiology, primary care), and pre-phase therapy should be considered for most patients. Treatment for fit older HL patients should be given with curative intent, including anthracyclines, and bleomycin should be minimized (or avoided). Brentuximab vedotin given sequentially before and after doxorubicin, vinblastine, dacarbazine (AVD) chemotherapy for untreated patients is tolerable and effective, and frontline checkpoint inhibitor/AVD platforms are rapidly emerging. Therapy for patients who are unfit or frail, whether due to comorbidities and/or ADL loss, is less clear and should be individualized with consideration of attenuated anthracycline-based therapy versus lower-intensity regimens with inclusion of brentuximab vedotin +/- checkpoint inhibitors. For all patients, there should be clinical vigilance with close monitoring for treatment-related toxicities, including neurotoxicity, cardiopulmonary, and infectious complications. Finally, active surveillance for "postacute" complications 1 to 10 years post therapy, especially cardiac disease, is needed for cured patients. Altogether, therapy for older HL patients should include anthracycline-based therapy in most cases, and novel targeted agents should continue to be integrated into treatment paradigms, with more research needed on how best to utilize GAs for treatment decisions.
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Affiliation(s)
- Andrew M. Evens
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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Li J, Shen G, Liu Z, Liu Y, Wang M, Zhao F, Ren D, Xie Q, Li Z, Liu Z, Zhao Y, Ma F, Liu X, Xu Z, Zhao J. Treatment-related adverse events of antibody-drug conjugates in clinical trials: A systematic review and meta-analysis. CANCER INNOVATION 2023; 2:346-375. [PMID: 38090386 PMCID: PMC10686142 DOI: 10.1002/cai2.97] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/06/2023] [Accepted: 09/11/2023] [Indexed: 10/15/2024]
Abstract
Background The wide use of antibody-drug conjugates (ADCs) is transforming the cancer-treatment landscape. Understanding the treatment-related adverse events (AEs) of ADCs is crucial for their clinical application. We conducted a meta-analysis to analyze the profile and incidence of AEs related to ADC use in the treatment of solid tumors and hematological malignancies. Methods We searched the PubMed, Embase, and Cochrane Library databases for articles published from January 2001 to October 2022. The overall profile and incidence of all-grade and grade ≥ 3 treatment-related AEs were the primary outcomes of the analysis. Results A total of 138 trials involving 15,473 patients were included in this study. The overall incidence of any-grade treatment-related AEs was 100.0% (95% confidence interval [CI]: 99.9%-100.0%; I 2 = 89%) and the incidence of grade ≥ 3 treatment-related AEs was 6.2% (95% CI: 3.0%-12.4%; I² = 99%). Conclusions This study provides a comprehensive overview of AEs related to ADCs used for cancer treatment. ADC use resulted in a high incidence of any-grade AEs but a low incidence of grade ≥ 3 AEs. The AE profiles and incidence differed according to cancer type, ADC type, and ADC components.
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Affiliation(s)
- Jinming Li
- Breast Disease Diagnosis and Treatment CenterAffiliated Hospital of Qinghai University, Affiliated Cancer Hospital of Qinghai UniversityXiningQinghaiChina
- Qinghai Provincial Clinical Research Center for Cancer; Qinghai Provincial Institute of Cancer ResearchXiningQinghaiChina
| | - Guoshuang Shen
- Breast Disease Diagnosis and Treatment CenterAffiliated Hospital of Qinghai University, Affiliated Cancer Hospital of Qinghai UniversityXiningQinghaiChina
- Qinghai Provincial Clinical Research Center for Cancer; Qinghai Provincial Institute of Cancer ResearchXiningQinghaiChina
| | - Zhen Liu
- Breast Disease Diagnosis and Treatment CenterAffiliated Hospital of Qinghai University, Affiliated Cancer Hospital of Qinghai UniversityXiningQinghaiChina
- Qinghai Provincial Clinical Research Center for Cancer; Qinghai Provincial Institute of Cancer ResearchXiningQinghaiChina
| | - Yaobang Liu
- Department of Surgical OncologyGeneral Hospital of Ningxia Medical UniversityYinchuanNingxia Hui Autonomous RegionChina
| | - Miaozhou Wang
- Breast Disease Diagnosis and Treatment CenterAffiliated Hospital of Qinghai University, Affiliated Cancer Hospital of Qinghai UniversityXiningQinghaiChina
- Qinghai Provincial Clinical Research Center for Cancer; Qinghai Provincial Institute of Cancer ResearchXiningQinghaiChina
| | - Fuxing Zhao
- Breast Disease Diagnosis and Treatment CenterAffiliated Hospital of Qinghai University, Affiliated Cancer Hospital of Qinghai UniversityXiningQinghaiChina
- Qinghai Provincial Clinical Research Center for Cancer; Qinghai Provincial Institute of Cancer ResearchXiningQinghaiChina
| | - Dengfeng Ren
- Breast Disease Diagnosis and Treatment CenterAffiliated Hospital of Qinghai University, Affiliated Cancer Hospital of Qinghai UniversityXiningQinghaiChina
- Qinghai Provincial Clinical Research Center for Cancer; Qinghai Provincial Institute of Cancer ResearchXiningQinghaiChina
| | - Qiqi Xie
- Breast Disease Diagnosis and Treatment CenterAffiliated Hospital of Qinghai University, Affiliated Cancer Hospital of Qinghai UniversityXiningQinghaiChina
- Qinghai Provincial Clinical Research Center for Cancer; Qinghai Provincial Institute of Cancer ResearchXiningQinghaiChina
| | - Zitao Li
- Breast Disease Diagnosis and Treatment CenterAffiliated Hospital of Qinghai University, Affiliated Cancer Hospital of Qinghai UniversityXiningQinghaiChina
- Qinghai Provincial Clinical Research Center for Cancer; Qinghai Provincial Institute of Cancer ResearchXiningQinghaiChina
| | - Zhilin Liu
- Breast Disease Diagnosis and Treatment CenterAffiliated Hospital of Qinghai University, Affiliated Cancer Hospital of Qinghai UniversityXiningQinghaiChina
- Qinghai Provincial Clinical Research Center for Cancer; Qinghai Provincial Institute of Cancer ResearchXiningQinghaiChina
| | - Yi Zhao
- Breast Disease Diagnosis and Treatment CenterAffiliated Hospital of Qinghai University, Affiliated Cancer Hospital of Qinghai UniversityXiningQinghaiChina
- Qinghai Provincial Clinical Research Center for Cancer; Qinghai Provincial Institute of Cancer ResearchXiningQinghaiChina
| | - Fei Ma
- Breast Disease Diagnosis and Treatment CenterAffiliated Hospital of Qinghai University, Affiliated Cancer Hospital of Qinghai UniversityXiningQinghaiChina
- Qinghai Provincial Clinical Research Center for Cancer; Qinghai Provincial Institute of Cancer ResearchXiningQinghaiChina
| | - Xinlan Liu
- Department of Surgical OncologyGeneral Hospital of Ningxia Medical UniversityYinchuanNingxia Hui Autonomous RegionChina
| | | | - Jiuda Zhao
- Breast Disease Diagnosis and Treatment CenterAffiliated Hospital of Qinghai University, Affiliated Cancer Hospital of Qinghai UniversityXiningQinghaiChina
- Qinghai Provincial Clinical Research Center for Cancer; Qinghai Provincial Institute of Cancer ResearchXiningQinghaiChina
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Wang Y, Wang Z, Wei C, Zhao D, Zhang Y, Wang W, Zhang W, Zhou D. Single-agent brentuximab vedotin as frontline therapy for Hodgkin lymphoma patients with severe hepatic impairment: a report of two cases. Ann Hematol 2023; 102:2973-2975. [PMID: 37522969 DOI: 10.1007/s00277-023-05390-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/26/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Yupeng Wang
- School of Medicine, Tsinghua University, Beijing, China
| | - Zi Wang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100005, China
| | - Chong Wei
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100005, China
| | - Danqing Zhao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100005, China
| | - Yan Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100005, China
| | - Wei Wang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100005, China.
| | - Wei Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100005, China
| | - Daobin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100005, China
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Vassilakopoulos TP, Liaskas A, Pereyra P, Panayiotidis P, Angelopoulou MK, Gallamini A. Incorporating Monoclonal Antibodies into the First-Line Treatment of Classical Hodgkin Lymphoma. Int J Mol Sci 2023; 24:13187. [PMID: 37685994 PMCID: PMC10487754 DOI: 10.3390/ijms241713187] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/06/2023] [Accepted: 08/09/2023] [Indexed: 09/10/2023] Open
Abstract
The long-term survival of Hodgkin lymphoma (HL) patients treated according to the current standard of care is excellent. Combined-modality schedules (ABVD plus radiotherapy) in early-stage disease, along with treatment intensity adaptation to early metabolic response assessed by PET/CT in advanced stage HL, have been the cornerstones of risk stratification and treatment decision-making, minimizing treatment-related complications while keeping efficacy. Nevertheless, a non-negligible number of patients are primary refractory or relapse after front-line treatment. Novel immunotherapeutic agents, namely Brentuximab Vedotin (BV) and immune checkpoint inhibitors (CPI), have already shown outstanding efficacy in a relapsed/refractory setting in recent landmark studies. Several phase 2 single-arm studies suggest that the addition of these agents in the frontline setting could further improve long-term disease control permitting one to reduce the exposure to cytotoxic drugs. However, a longer follow-up is needed. At the time of this writing, the only randomized phase 3 trial so far published is the ECHELON-1, which compares 1 to 1 BV-AVD (Bleomycin is replaced by BV) with standard ABVD in untreated advanced-stage III and IV HL. The ECHELON-1 trial has proven that BV-AVD is safe and more effective both in terms of long-term disease control and overall survival. Just recently, the results of the S1826 SWOG trial demonstrated that the combination nivolumab-AVD (N-AVD) is better than BV-AVD, while preliminary results of other randomized ongoing phase 3 trials incorporating anti-PD-1 in this setting will be soon available. The aim of this review is to present the recent data regarding these novel agents in first-line treatment of HL and to highlight current and future trends which will hopefully reshape the overall management of this disease.
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Affiliation(s)
- Theodoros P. Vassilakopoulos
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece; (A.L.); (P.P.); (M.K.A.)
| | - Athanasios Liaskas
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece; (A.L.); (P.P.); (M.K.A.)
| | - Patricio Pereyra
- Department of Hematology, National Hospital Alejandro Posadas, Buenos Aires 1684, Argentina;
| | - Panayiotis Panayiotidis
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece; (A.L.); (P.P.); (M.K.A.)
| | - Maria K. Angelopoulou
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece; (A.L.); (P.P.); (M.K.A.)
| | - Andrea Gallamini
- Research and Clinical Innovation Department, Antoine Lacassagne Cancer Center, 06100 Nice, France;
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10
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Current Treatment Options and the Role of Functional Status Assessment in Classical Hodgkin Lymphoma in Older Adults: A Review. Cancers (Basel) 2023; 15:cancers15051515. [PMID: 36900306 PMCID: PMC10000520 DOI: 10.3390/cancers15051515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Along with the fact that classical Hodgkin lymphoma (cHL) in older adults is frequently considered biologically different from cHL in younger patients, its most distinctive feature is its dismal clinical outcome due to the decreased effectiveness and greater toxicity of therapies. Although strategies to mitigate specific toxicities (e.g., cardiological and pulmonary) have obtained some results, in general, reduced-intensity schemes, proposed as an alternative to ABVD, have proved to be less effective. The addition of brentuximab vedotin (BV) to AVD, especially in a sequential scheme, has demonstrated good efficacy. However, the problem of toxicity persists even with this new therapeutic combination, with comorbidities remaining an important prognostic factor. The adequate stratification of functional status is necessary to distinguish between those patients who will benefit from full treatment and those who will benefit from alternative strategies. A simplified geriatric assessment based on the determination of ADL (activity of daily living), IADL (instrumental ADL), and CIRS-G (Cumulative Illness Rating Scale-Geriatric) scores is an easy-to-use tool that permits adequate patient stratification. Other factors of considerable impact on functional status such as sarcopenia and immunosenescence are currently being studied. A fitness-based treatment choice would also be very useful for relapsed or refractory patients, a more frequent and challenging situation than that is found in young cHL patients.
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Gampa SC, Garimella SV, Pandrangi S. Nano-TRAIL: a promising path to cancer therapy. CANCER DRUG RESISTANCE (ALHAMBRA, CALIF.) 2023; 6:78-102. [PMID: 37065863 PMCID: PMC10099604 DOI: 10.20517/cdr.2022.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/20/2022] [Accepted: 01/04/2023] [Indexed: 04/18/2023]
Abstract
Tumor Necrosis Factor-Related Apoptosis-Inducing Ligand, also called apo-2 ligand (TRAIL/Apo-2L), is a cytokine that triggers apoptosis by binding to TRAIL-R1 (DR4) and TRAIL-R2 (DR5) death receptors. Apoptosis occurs through either the extrinsic or intrinsic pathway. The administration of recombinant human TRAIL (rhTRAIL) or TRAIL-receptor (TRAIL-R) agonists promotes apoptosis preferentially in cancerous cells over normal cells in vitro; this phenomenon has also been observed in clinical studies. The limited efficacy of rhTRAIL in clinical trials could be attributed to drug resistance, short half-life, targeted delivery issues, and off-target toxicities. Nanoparticles are excellent drug and gene delivery systems characterized by improved permeability and retention, increased stability and biocompatibility, and precision targeting. In this review, we discuss resistance mechanisms to TRAIL and methods to overcome TRAIL resistance by using nanoparticle-based formulations developed for the delivery of TRAIL peptides, TRAIL-R agonists, and TRAIL genes to cancer cells. We also discuss combinatorial approaches of chemotherapeutic drugs with TRAIL. These studies demonstrate TRAIL's potential as an anticancer agent.
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Affiliation(s)
- Siri Chandana Gampa
- Department of Biotechnology, Institute of Science, GITAM (Deemed to be University), Andhra Pradesh 530045, India
| | - Sireesha V. Garimella
- Department of Biotechnology, Institute of Science, GITAM (Deemed to be University), Andhra Pradesh 530045, India
| | - SanthiLatha Pandrangi
- Department of Biochemistry and Bioinformatics, Institute of Science, GITAM (Deemed to be University), Andhra Pradesh 530045, India
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12
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Goh Z, Latimer M, Lewis KL, Cheah CY, Ciaccio PD, Cushion T, Hawkes EA, Harrop S, Ku M, Campbell A, Hamad N, Wood EM, Chung E, Chen PY, Cochrane T. Characteristics and Outcomes of Older Patients With Classical Hodgkin Lymphoma: An Australasian Lymphoma Alliance, and Lymphoma and Related Diseases Registry Study. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:370-378. [PMID: 36804727 DOI: 10.1016/j.clml.2023.01.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/21/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is no standard front-line therapy for older patients with classical Hodgkin lymphoma (cHL). We analyzed the clinical presentation and front-line management of older Australian patients with cHL and explored factors associated with unplanned hospital admission and survival. METHODS Patients aged ≥ 61 years and diagnosed between 2011 and 2020, were retrospectively identified through the Lymphoma and Related Diseases Registry (LaRDR) and Australasian Lymphoma Alliance (ALA) institutional databases. Descriptive statistics and Kaplan-Meier survival analyses were performed using STATA-v17. RESULTS 195 patients were identified, 72 from LaRDR,123 from ALA. Median age of the combined cohort was 72 years (range 61-93); 56.4% male, 35.3% had stage I-II, bulk present in 9.2%, 33.9% had extra-nodal disease and 48.2% had B-symptoms. Chemotherapy was commenced in 91.3% of patients, with an anthracycline-based regimen used in 81%. Median number of cycles given for stage I-II was 2 and for stage III-IV was 6. Radiotherapy was administered in 26.2% of patients. A complete remission to front-line chemotherapy was achieved in 60.7% of patients. During front-line therapy in the ALA cohort, 89 unplanned hospitalizations occurred in 58 patients, with infection accounting for 59.6% of admissions. Treatment-related mortality was 5.2%. Only performance status and anthracycline use correlated with unplanned hospitalizations. Estimated 2-year progression free survival was 63.7% and 2-year overall survival was 71.2%. Anthracycline use and younger age were independently associated with improved survival. CONCLUSION The management of older patients with cHL in Australia is diverse but aligns with international data. Anthracycline-based therapy improved survival but resulted in frequent unplanned hospitalizations.
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Affiliation(s)
- Zhong Goh
- Department of Haematology, Gold Coast University Hospital, Southport, Queensland, Australia; Griffith University, Southport, Queensland, Australia
| | - Maya Latimer
- ACT Pathology and Canberra Hospital, Canberra, Australia; Australian National University, Canberra, Australia
| | - Katharine L Lewis
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia; Division Medical School, University of Western Australia, Perth, WA, Australia; WA Linear Clinical Research, Nedlands, WA, Australia
| | - Chan Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia; Division Medical School, University of Western Australia, Perth, WA, Australia
| | - Pietro Di Ciaccio
- Australian National University, Canberra, Australia; Department of Haematology Sydney Adventist Hospital, Wahroonga NSW, Australia; University of New South Wales, Randwick, NSW, Australia
| | - Tania Cushion
- Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Eliza A Hawkes
- Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Heidelberg, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sean Harrop
- Department of Haematology, St Vincent's hospital, Fitzroy, Victoria, Australia
| | - Matthew Ku
- Department of Haematology, St Vincent's hospital, Fitzroy, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
| | - Ashlea Campbell
- Department of Haematology and Bone Marrow Transplant, St Vincent's Hospital, Sydney, NSW, Australia
| | - Nada Hamad
- Department of Haematology and Bone Marrow Transplant, St Vincent's Hospital, Sydney, NSW, Australia; School of Clinical Medicine, UNSW Medicine and Health, Sydney, Australia; School of Medicine, Sydney, University of Notre Dame Australia, Sydney, Australia
| | - Erica M Wood
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Monash Health, Clayton, Victoria, Australia
| | - Eliza Chung
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Pin-Yen Chen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tara Cochrane
- Department of Haematology, Gold Coast University Hospital, Southport, Queensland, Australia; Griffith University, Southport, Queensland, Australia.
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13
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Barrett A, Collins GP. Older patients with Hodgkin Lymphoma: Walking the tightrope of efficacy and toxicity. Front Oncol 2023; 12:1017787. [PMID: 36713561 PMCID: PMC9880490 DOI: 10.3389/fonc.2022.1017787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/11/2022] [Indexed: 01/15/2023] Open
Abstract
Since its initial description, classical Hodgkin lymphoma (cHL) portends a greatly improved prognosis and the goal of treatment in most patients is cure with minimisation of toxicity from treatment. Outcomes in older patients (>60 years old) lag behind those of their younger counterparts however, and cure remains achievable mostly for those who can tolerate full doses of conventional chemotherapy. This review addresses the difference in biology between younger and older patients with cHL and examines the impact of frailty and comorbidities on outcomes. The toxicities of conventional chemotherapy in anthracycline-fit and -unfit patients are examined, with a particular focus on pulmonary toxicity associated with bleomycin in older patients. New advances are discussed, including the possibility of using more targeted therapies such as the anti-CD30 antibody brentuximab vedotin (BV) and checkpoint inhibitors as a method of reducing dependency on conventional chemotherapy for those less well able to tolerate it. Treatment of older patients with cHL remains an area of unmet need in hematological research, and efforts to rectify this knowledge gap should continue.
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14
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Kambhampati S, Herrera AF. Incorporating novel agents into frontline treatment of Hodgkin lymphoma. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:706-716. [PMID: 36485085 PMCID: PMC9820976 DOI: 10.1182/hematology.2022000363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Classical Hodgkin lymphoma (cHL) is associated with excellent outcomes with standard frontline chemotherapy or combined modality therapy. However, up to 25% of patients will have relapsed or primary refractory (RR) cHL. Improving the cure rate with frontline treatment, treatment-related complications and late effects, and poor therapy tolerance with high relapse rates in older patients are unmet needs in the initial management of cHL. The introduction of novel therapies, including the CD30-directed antibody drug conjugate brentuximab vedotin and PD-1 blockade (ie, pembrolizumab or nivolumab), has transformed the treatment of RR cHL and has the potential to address these unmet needs in the frontline setting. Incorporation of these potent, targeted immunotherapies into frontline therapy may improve outcomes, may allow for de-escalation of therapy without sacrificing efficacy to reduce treatment complications, and may allow for well-tolerated and targeted escalation of therapy for patients demonstrating an insufficient response. In this article, we provide a case-based approach to the use of novel agents in the frontline treatment of cHL.
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Affiliation(s)
- Swetha Kambhampati
- Department of Hematology and Hematopoietic Stem Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Alex F Herrera
- Department of Hematology and Hematopoietic Stem Cell Transplantation, City of Hope National Medical Center, Duarte, CA
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15
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Clinical Dilemmas in the Treatment of Elderly Patients Suffering from Hodgkin Lymphoma: A Review. Biomedicines 2022; 10:biomedicines10112917. [PMID: 36428485 PMCID: PMC9687245 DOI: 10.3390/biomedicines10112917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/02/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022] Open
Abstract
Elderly patients make up a significant number of cases of newly diagnosed Hodgkin lymphoma. However, unlike in young patients, the outcomes of elderly patients are poor, and they are under-represented in phase III trials. Prior to treatment initiation, geriatric assessment should ideally be performed to address the patient's fitness and decide whether to pursue a curative or palliative approach. The ABVD regimen is poorly tolerated in unfit patients, with high treatment-related mortality. Alternative chemotherapy approaches have been explored, with mixed results obtained concerning their feasibility and toxicity in phase II trials. The introduction of brentuximab vedotin-based regimens led to a paradigm shift in first- and further-line treatment of elderly Hodgkin lymphoma patients, providing adequate disease control within a broader patient population. As far as checkpoint inhibitors are concerned, we are only just beginning to understand the role in the treatment of this population. In relapsed/refractory settings there are few options, ranging from autologous stem cell transplantation in selected patients to pembrolizumab, but unfortunately, palliative care is the most common modality. Importantly, published studies are frequently burdened with numerous biases (such as low numbers of patients, selection bias and lack of geriatric assessment), leading to low level of evidence. Furthermore, there are few ongoing studies on this topic. Thus, elderly Hodgkin lymphoma patients are hard to treat and represent an unmet need in hematologic oncology. In conclusion, treatment needs to be personalized and tailored on a case-by-case basis. In this article, we outline treatment options for elderly Hodgkin lymphoma patients.
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16
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Evens AM, Connors JM, Younes A, Ansell SM, Kim WS, Radford J, Feldman T, Tuscano J, Savage KJ, Oki Y, Grigg A, Pocock C, Dlugosz-Danecka M, Fenton K, Forero-Torres A, Liu R, Jolin H, Gautam A, Gallamini A. Older patients (aged ≥60 years) with previously untreated advanced-stage classical Hodgkin lymphoma: a detailed analysis from the phase III ECHELON-1 study. Haematologica 2022; 107:1086-1094. [PMID: 34162178 PMCID: PMC9052913 DOI: 10.3324/haematol.2021.278438] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/17/2021] [Indexed: 11/09/2022] Open
Abstract
Effective and tolerable treatments are needed for older patients with classical Hodgkin lymphoma. We report results for older patients with classical Hodgkin lymphoma treated in the large phase III ECHELON-1 study of frontline brentuximab vedotin plus doxorubicin, vinblastine, and dacarbazine (A+AVD) versus doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). Modified progression-free survival per independent review facility for older versus younger patients (aged ≥60 vs. <60 years) was a pre-specified subgroup analysis; as the ECHELON- 1 study was not powered for these analyses, reported P-values are descriptive. Of 1,334 enrolled patients, 186 (14%) were aged ≥60 years (A+AVD: n=84, ABVD: n=102); results below refer to this age group. Modified progression-free survival per independent review facility was similar in the two arms at 24 months (A+AVD: 70.3% [95% confidence interval (CI): 58.4-79.4], ABVD: 71.4% [95% CI: 60.5-79.8], hazard ratio (HR)=1.00 [95% CI: 0.58-1.72], P=0.993). After a median follow-up of 60.9 months, 5-year progression-free survival per investigator was 67.1% with A+AVD versus 61.6% with ABVD (HR=0.820 [95% CI: 0.494-1.362], P=0.443). Comparing A+AVD versus ABVD, grade 3/4 peripheral neuropathy occurred in 18% versus 3%; any-grade febrile neutropenia in 37% versus 17%; and any-grade pulmonary toxicity in 2% versus 13%, respectively, with three (3%) pulmonary toxicity-related deaths in patients receiving ABVD (none in those receiving A+AVD). Altogether, A+AVD showed overall similar efficacy to ABVD with survival rates in both arms comparing favorably to those of prior series in older patients with advanced-stage classical Hodgkin lymphoma. Compared to ABVD, A+AVD was associated with higher rates of neuropathy and neutropenia, but lower rates of pulmonary-related toxicity. Trials registered at ClinicalTrials.gov identifiers: NCT01712490; EudraCT number: 2011-005450-60.
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Affiliation(s)
- Andrew M Evens
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
| | - Joseph M Connors
- BC Cancer Centre for Lymphoid Cancer and Department of Medical Oncology, Vancouver
| | | | | | - Won Seog Kim
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul
| | - John Radford
- University of Manchester and the Christie NHS Foundation Trust Manchester Academic Health Science Centre, Manchester
| | | | | | - Kerry J Savage
- BC Cancer Centre for Lymphoid Cancer and Department of Medical Oncology, Vancouver
| | | | - Andrew Grigg
- Olivia Newton-John Cancer Wellness and Research Centre, Austin Health and Department of Clinical Haemotology, Austin Hospital, Heidelberg
| | | | | | | | | | - Rachael Liu
- Millennium Pharmaceuticals, Inc., Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | - Hina Jolin
- Millennium Pharmaceuticals, Inc., Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | - Ashish Gautam
- Millennium Pharmaceuticals, Inc., Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | - Andrea Gallamini
- Research and Innovation Department, A Lacassagne Cancer Centre, Nice
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17
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Miyazaki K. Management of elderly patients with malignant lymphoma. Jpn J Clin Oncol 2022; 52:690-699. [PMID: 35435235 DOI: 10.1093/jjco/hyac056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 04/02/2022] [Indexed: 11/14/2022] Open
Abstract
More than half of patients with malignant lymphoma are 65 years old or older. The outcome for older patients is poorer than that for younger patients. A poor prognosis is associated with heterogeneity and consists of physical function, performance status, poor nutritional status and various comorbidities. Therefore, attention should be given to serious treatment-related toxicities. Diffuse large B-cell lymphoma is the most frequently diagnosed type of malignant lymphoma. Most patients with diffuse large B-cell lymphoma can be potentially cured with the current standard chemotherapeutic regimen of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone. However, a reduced-dose regimen of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone or alternative treatment options might be suitable for older patients who are frail or unfit and have cardiac comorbidities. A comprehensive geriatric assessment is a potential tool for determining an appropriate therapeutic approach for each older patient. Follicular lymphoma is the second most common type of non-Hodgkin lymphoma, and the disease course is usually characterized by an indolent clinical course. Advanced follicular lymphoma with a high tumor burden has historically been treated with chemoimmunotherapy, but the treatment goal for older patients is relief of symptoms. Incorporating novel targeted agents such as brentuximab vedotin into therapies for older Hodgkin lymphoma patients might be a promising alternative to the anthracycline-containing regimen.
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Affiliation(s)
- Kana Miyazaki
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Japan
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18
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Schwarting R, Behling E, Allen A, Arguello-Guerra V, Budak-Alpdogan T. CD30+ Lymphoproliferative Disorders as Potential Candidates for CD30-Targeted Therapies. Arch Pathol Lab Med 2022; 146:415-432. [PMID: 35299246 DOI: 10.5858/arpa.2021-0338-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— In the early 1980s, a monoclonal antibody termed Ki-1 was developed against a cell line derived from a patient with Hodgkin lymphoma. This antibody detected a limited number of benign activated lymphocytes in lymphoid tissue, whereas in Hodgkin lymphoma it appeared to be nearly specific for Reed-Sternberg cells and their mononuclear variants. Subsequent studies showed that Ki-1 expression defined a new type of lymphoma that was later designated anaplastic large cell lymphoma with or without anaplastic large cell kinase expression/translocation. In the past 30 years, numerous new lymphoma entities have been defined, many of which are variably positive for CD30. Many virally transformed lymphoproliferative disorders are also frequently positive for CD30. OBJECTIVE.— To illustrate the broad spectrum of CD30+ hematologic malignancies and to provide an update of CD30-targeted therapies. DATA SOURCES.— Personal experiences and published works in PubMed. CONCLUSIONS.— Because of its low expression in normal tissue, CD30 was studied as a therapeutic target for many years. However, the first functional humanized antibody against CD30 was developed only about 10 years ago. Brentuximab vedotin is a humanized anti-CD30 antibody linked to a cytotoxin, and was approved by the US Food and Drug Administration in 2012 for treating refractory Hodgkin lymphoma and anaplastic large cell lymphoma. Since then, the list of Food and Drug Administration-approved CD30-targeted hematologic malignancies has grown. Recently, the therapies using tumor antigen-specific chimeric antigen receptor T cells targeting CD30 have incited a great deal of enthusiasm and are studied in clinical trials.
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Affiliation(s)
- Roland Schwarting
- From the Department of Pathology, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, New Jersey (Schwarting, Behling, Allen, Arguello-Guerra)
| | - Eric Behling
- From the Department of Pathology, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, New Jersey (Schwarting, Behling, Allen, Arguello-Guerra)
| | - Ashleigh Allen
- From the Department of Pathology, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, New Jersey (Schwarting, Behling, Allen, Arguello-Guerra)
| | - Vivian Arguello-Guerra
- From the Department of Pathology, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, New Jersey (Schwarting, Behling, Allen, Arguello-Guerra)
| | - Tulin Budak-Alpdogan
- MD Anderson Cancer Center at Cooper, Department of Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, New Jersey (Budak-Alpdogan)
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19
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Khan M, Hagemeister F, Wang M, Ahmed S. A review of pathobiology and therapies for classic Hodgkin lymphoma. Blood Rev 2022; 55:100949. [DOI: 10.1016/j.blre.2022.100949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 02/12/2022] [Accepted: 03/22/2022] [Indexed: 11/27/2022]
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20
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Follows GA, Barrington SF, Bhuller KS, Culligan DJ, Cutter DJ, Gallop-Evans E, Kassam S, Osborne W, Sadullah S, Townsend W, Uttenthal BJ, Collins GP. Guideline for the first-line management of Classical Hodgkin Lymphoma - A British Society for Haematology guideline. Br J Haematol 2022; 197:558-572. [PMID: 35191541 DOI: 10.1111/bjh.18083] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/21/2022] [Accepted: 01/27/2022] [Indexed: 12/21/2022]
Abstract
This guideline was compiled according to the British Society for Haematology (BSH) process at https://b-s-h.org.uk/media/16732/bsh-guidance-development-process-dec-5-18.pdf. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) nomenclature was used to evaluate levels of evidence and to assess the strength of recommendations. The GRADE criteria can be found at http://www.gradeworkinggroup.org. Recommendations are based on a review of the literature using Medline, PubMed/Medline and Cochrane searches beginning from 2013 up to January 2021. The following search terms were used: [Hodgkin lymphoma OR Hodgkin disease] NOT non-Hodgkin; AND [chemotherapy OR radiotherapy]; AND [elderly]; AND [teenage OR adolescent OR young adult]; AND [pregnancy]. Filters were applied to include only publications written in English, studies carried out in humans, clinical conferences, congresses, clinical trials, clinical studies, meta-analyses, multicentre studies and randomised controlled trials. References pre-2013 were taken from the previous version of this guideline.1 Review of the manuscript was performed by the British Society for Haematology (BSH) Guidelines Committee Haematology Oncology Taskforce, the BSH Guidelines Committee and the Haematology Oncology sounding board of BSH.
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Affiliation(s)
- George A Follows
- Department of Haematology, Cambridge University Teaching Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sally F Barrington
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - Kaljit S Bhuller
- Paediatric, Teenage & Young Adult (TYA) Haematology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - David J Cutter
- Department of Oncology, Oxford Cancer and Haematology Centre, University of Oxford, Oxford, UK
| | | | - Shireen Kassam
- Department of Haematology, King's College Hospital NHS Foundation Trust, London, UK
| | - Wendy Osborne
- Department of Haematology, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle, UK
| | - Shalal Sadullah
- Department of Haematology, James Paget University Hospital, Great Yarmouth, UK
| | - William Townsend
- Department of Haematology, University College Hospital London Hospitals NHS Trust, London, UK
| | - Benjamin J Uttenthal
- Department of Haematology, Cambridge University Teaching Hospitals NHS Foundation Trust, Cambridge, UK
| | - Graham P Collins
- Department of Clinical Haematology, Oxford Cancer and Haematology Centre, University of Oxford, Oxford, UK
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21
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Neurotoxicity of Tumor Immunotherapy: The Emergence of Clinical Attention. JOURNAL OF ONCOLOGY 2022; 2022:4259205. [PMID: 35087588 PMCID: PMC8789457 DOI: 10.1155/2022/4259205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 02/05/2023]
Abstract
Tumor immunotherapy brings substantial and long-term clinical benefits that can even cure tumors. However, the accumulation of evidence suggests that immunotherapy also induces severe and complex neurologic immune-related adverse events (ir-AEs) and even leads to immunotherapy-related death, which arouses the concern of clinicians. The timely and accurate identification of neurotoxicity helps clinicians detect and treat these complications early, thereby enhancing treatment efficiency and improving the prognosis of patients. At present, the mechanism of neurotoxicity caused by immunotherapy has not been completely elucidated. This paper mainly reviews the clinical features, pathogenesis, and therapeutic strategies of neurologic ir-AEs.
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22
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Velasco R, Domingo-Domenech E, Sureda A. Brentuximab-Induced Peripheral Neurotoxicity: A Multidisciplinary Approach to Manage an Emerging Challenge in Hodgkin Lymphoma Therapy. Cancers (Basel) 2021; 13:6125. [PMID: 34885234 PMCID: PMC8656789 DOI: 10.3390/cancers13236125] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/27/2021] [Accepted: 11/30/2021] [Indexed: 01/30/2023] Open
Abstract
Brentuximab vedotin (BV) is an anti-CD30 antibody-drug conjugate approved to treat classical Hodgkin lymphoma (HL). BV-induced peripheral neurotoxicity (BVIN) is one of the greatest concerns for haematologists treating HL for several reasons. First, BVIN is highly frequent. Most patients receiving BV will experience some degree of BVIN, resulting in the primary reason for dose modification or discontinuation of HL therapy. Second, BV produces sensory, motor, and/or autonomic peripheral nerve dysfunction, which can present as severe, disabling forms of BVIN-predominantly motor-in some patients. Third, although largely reversible, BVIN may persist months or years after treatment and thereby become a major issue in HL survivorship. BVIN may, therefore, negatively affect the quality of life and work-life of often young patients with HL, in whom long-term survival is expected. Currently, the only strategy for BVIN includes dose adjustments and treatment discontinuation; however, this could interfere with LH therapy efficacy. In this setting, early recognition and adequate management of BVIN are critical in improving clinical outcomes. Careful neurologic monitoring may allow accurate diagnoses and gradation of ongoing forms of BVIN presentation. This review analysed current, available data on epidemiology, pathophysiology, patient- and treatment-related risk factors, clinical and neurophysiologic phenotypes, and management in patients with HL. Furthermore, this review specifically addresses limitations posed by BVIN assessments in clinical practice and provides skills and tools to improve neurologic assessments in these patients. Integrating this neurotoxic drug in clinical practice requires a multidisciplinary approach to avoid or minimise neurotoxicity burden in survivors of HL.
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Affiliation(s)
- Roser Velasco
- Neuro-Oncology Unit, Department of Neurology, Hospital Universitari de Bellvitge-Institut Català dOncologia, 08908 Barcelona, Spain
- Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, 08193 Bellaterra, Spain
| | - Eva Domingo-Domenech
- Department of Haematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, University of Barcelona (UB), L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (E.D.-D.); (A.S.)
| | - Anna Sureda
- Department of Haematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, University of Barcelona (UB), L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (E.D.-D.); (A.S.)
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23
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Brice P, de Kerviler E, Friedberg JW. Classical Hodgkin lymphoma. Lancet 2021; 398:1518-1527. [PMID: 33493434 DOI: 10.1016/s0140-6736(20)32207-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 06/11/2020] [Accepted: 10/15/2020] [Indexed: 11/29/2022]
Abstract
Classical Hodgkin lymphoma is one of the more frequent lymphomas and is generally considered a highly curable disease with standard first-line chemotherapy and radiotherapy in some cases. Despite these outstanding results, major problems remain unresolved. First, there are still patients who will not be cured with front-line regimens and, second, many patients who are cured of classical Hodgkin lymphoma continue to die prematurely due to the late toxic effects of their therapy. Because the median age of patients with classical Hodgkin lymphoma is in the mid-30s, the disease's impact on the number of years lost from productive life is remarkable. In recent years, the gold standard of chemotherapy (often combined with radiotherapy) has changed, with the approval of immunotherapy mostly in relapse settings.
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Affiliation(s)
- Pauline Brice
- Department of Oncohaematology, Hôpital saint Louis APHP, Université Paris 7, Paris, France.
| | - Eric de Kerviler
- Department of Radiology, Hôpital saint Louis APHP, Université Paris 7, Paris, France
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24
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Multicenter analysis of geriatric fitness and real-world outcomes in older patients with classical Hodgkin lymphoma. Blood Adv 2021; 5:3623-3632. [PMID: 34448831 DOI: 10.1182/bloodadvances.2021004645] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/29/2021] [Indexed: 11/20/2022] Open
Abstract
We performed a multicenter retrospective analysis across 10 US academic medical centers to evaluate treatment patterns and outcomes in patients age ≥60 years with classic Hodgkin lymphoma (cHL) from 2010-2018. Among 244 eligible patients, median age was 68, 63% had advanced stage (III/IV), 96% had Eastern Cooperative Oncology Group performance status (PS) 0-2, and 12% had documented loss of ≥1 activity of daily living (ADL). Medical comorbidities were assessed by the Cumulative Illness Rating Scale-Geriatric (CIRS-G), where n = 44 (18%) had total scores ≥10. Using multivariable Cox models, only ADL loss predicted shorter progression-free (PFS; hazard ratio [HR] 2.13, P = .007) and overall survival (OS; HR 2.52, P = .02). Most patients (n = 203, 83%) received conventional chemotherapy regimens, including doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD; 56%), AVD (14%), and AVD with brentuximab vedotin (BV; 9%). Compared to alternative therapies, conventional regimens significantly improved PFS (HR 0.46, P = .0007) and OS (HR 0.31, P = .0003). Survival was similar following conventional chemotherapy in those ages 60-69 vs ≥70: PFS HR 0.88, P = .63; OS HR 0.73, P = .55. Early treatment discontinuation due to toxicity was more common with CIRS-G ≥10 (28% vs 12%, P = .016) or documented geriatric syndrome (28% vs 13%, P = .02). A competing risk analysis demonstrated improved disease-related survival with conventional therapy (HR 0.29, P = .02) and higher mortality from causes other than disease or treatment with high CIRS-G or geriatric syndromes. This study suggests conventional chemotherapy regimens remain a standard of care in fit older patients with cHL, and highlights the importance of geriatric assessments in defining fitness for cHL therapy going forward.
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How we incorporate novel agents into the treatment of classic Hodgkin lymphoma. Blood 2021; 138:520-530. [PMID: 33889927 DOI: 10.1182/blood.2020007900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/26/2021] [Indexed: 11/20/2022] Open
Abstract
The introduction of targeted immunotherapies specifically, brentuximab vedotin (BV) and programmed death-1 (PD-1) blocking antibodies (nivolumab and pembrolizumab), has reshaped the therapeutic landscape of classic Hodgkin lymphoma (cHL) in the past decade. Targeting specific biologic features of cHL, these novel agents have expanded treatment options for patients with multiply rel/ref cHL and have increasingly been studied at earlier points in a patient's disease course. With the plethora of studies evaluating BV and PD-1 blockade as part of cHL therapy, often in non-randomized, controlled studies, more questions than answers have arisen about how to optimally integrate these drugs into clinical practice. In this article, we use a case-based format to offer practical guidance on how we incorporate BV and anti-PD1 antibodies into the management of cHL and review the data supporting those recommendations.
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Gibb A, Pirrie SJ, Linton K, Warbey V, Paterson K, Davies AJ, Collins GP, Menne T, McKay P, Fields PA, Miall FM, Nagy E, Wheatley K, Reed R, Baricevic-Jones I, Barrington S, Radford J. Results of a UK National Cancer Research Institute Phase II study of brentuximab vedotin using a response-adapted design in the first-line treatment of patients with classical Hodgkin lymphoma unsuitable for chemotherapy due to age, frailty or comorbidity (BREVITY). Br J Haematol 2021; 193:63-71. [PMID: 32926420 DOI: 10.1111/bjh.17073] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 08/04/2020] [Indexed: 11/25/2022]
Abstract
Standard treatment for classical Hodgkin lymphoma (cHL) is poorly tolerated in older patients and results disappointing. We assessed safety and efficacy of brentuximab vedotin (BV), in previously untreated patients with cHL unfit for standard treatment due to age, frailty or comorbidity. The primary outcome was complete metabolic response (CMR) by positron emission tomography/computed tomography after four BV cycles (PET4). The secondary outcomes included progression-free survival (PFS), overall survival (OS), and toxicity. In all, 35 patients with a median age of 77 years and median total Cumulative Illness Rating Scale for Geriatrics (CIRS-G) score of 6 were evaluable for toxicity and 31 for response. A median of four cycles were given (range one-16). In all, 14 patients required dose reduction due to toxicity and 11 patients stopped treatment due to adverse events (AEs). A total of 716 AEs were reported, of which 626 (88%) were Grade 1/2 and 27 (77%) patients had at least one AE Grade ≥3. At PET4, CMR was 25·8% [95% confidence interval (CI) 13·7-42.2%] and objective response rate 83·9% (95% CI 63·7-90·8%). Median PFS was 7·3 months (95% CI 5·2-9·0), and OS 19·5 months. Our results suggest that BV monotherapy is tolerable but suboptimal in the front-line therapy of elderly or comorbid patients with cHL. Combining BV with other agents may be more effective. Trial Registration: Clinicaltrials.gov identifier: NCT02567851.
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Affiliation(s)
- Adam Gibb
- National Institute for Health Research (NIHR) Manchester Clinical Research Facility, The Christie NHS Foundation Trust, Manchester, UK
| | - Sarah J Pirrie
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Kim Linton
- National Institute for Health Research (NIHR) Manchester Clinical Research Facility, The Christie NHS Foundation Trust, Manchester, UK
- University of Manchester, Manchester, UK
| | - Victoria Warbey
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, UK
| | - Kathryn Paterson
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Andrew J Davies
- Cancer Research UK Centre, Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Graham P Collins
- Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford, UK
| | | | - Pamela McKay
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | | | - Eszter Nagy
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Rachel Reed
- Stoller Biomarker Discovery Centre, University of Manchester, Manchester, UK
| | | | - Sally Barrington
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, UK
| | - John Radford
- National Institute for Health Research (NIHR) Manchester Clinical Research Facility, The Christie NHS Foundation Trust, Manchester, UK
- University of Manchester, Manchester, UK
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Andrade-Gonzalez X, Ansell SM. Novel Therapies in the Treatment of Hodgkin Lymphoma. Curr Treat Options Oncol 2021; 22:42. [PMID: 33755826 DOI: 10.1007/s11864-021-00840-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 12/22/2022]
Abstract
OPINION STATEMENT Patients with Hodgkin lymphoma (HL) can achieve excellent response and survival rates following frontline combination chemo- and radiation therapy. However, about 10-15% of patients will experience disease relapse which is associated with poor outcomes. Recent breakthroughs in understanding the mechanisms of oncogenicity and interactions within the tumor microenvironment have resulted in development of novel drugs for treatment of patients with HL. Utilizing this information, treatment of newly diagnosed and relapsed HL has become a rapidly evolving field with multiple clinical trials evaluating novel treatment approaches incorporating targeted immunotherapy. In the frontline setting, the use of novel drugs may allow for de-escalation of therapy to avoid long-term complications associated with bleomycin and consolidation radiation therapy. Patients with early-stage, non-bulky disease are candidates for omitting radiation therapy using treatment combinations that include upfront use of brentuximab vedotin or nivolumab. In patients with advanced disease, the addition of brentuximab vedotin to a chemotherapy backbone is currently the standard of care in our practice, particularly in patients with a contraindication for receiving bleomycin. Future investigations in patients with advanced-stage HL will focus on establishing a new standard of care by comparing brentuximab vedotin and nivolumab in combination with chemotherapy (BV-AVD vs. N-AVD) and decreasing the risk of relapse by exploring consolidation therapy in patients with high-risk disease. In patients who have relapsed or are refractory to first-line therapy, salvage treatment has incorporated brentuximab vedotin or PD-1 checkpoint inhibitors to improve response rates of cytotoxic chemotherapy thereby improving the probability of a successful stem cell transplant. Post-transplant consolidation with brentuximab is currently standard of care in patients with high-risk disease. Patients who relapse following autologous stem cell transplant now have an expanded armamentarium of chemo- and immunotherapy options. However, the challenge is to determine the sequence of therapy after prior brentuximab or checkpoint inhibitor exposure.
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Affiliation(s)
| | - Stephen M Ansell
- Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Azmi AS, Uddin MH, Mohammad RM. The nuclear export protein XPO1 - from biology to targeted therapy. Nat Rev Clin Oncol 2021; 18:152-169. [PMID: 33173198 DOI: 10.1038/s41571-020-00442-4] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 12/23/2022]
Abstract
Exportin 1 (XPO1), also known as chromosome region maintenance protein 1, plays a crucial role in maintaining cellular homeostasis via the regulated export of a range of cargoes, including proteins and several classes of RNAs, from the nucleus to the cytoplasm. Dysregulation of this protein plays a pivotal role in the development of various solid and haematological malignancies. Furthermore, XPO1 is associated with resistance to several standard-of-care therapies, including chemotherapies and targeted therapies, making it an attractive target of novel cancer therapies. Over the years, a number of selective inhibitors of nuclear export have been developed. However, only selinexor has been clinically validated. The novel mechanism of action of XPO1 inhibitors implies a different toxicity profile to that of other agents and has proved challenging in certain settings. Nonetheless, data from clinical trials have led to the approval of the XPO1 inhibitor selinexor (plus dexamethasone) as a fifth-line therapy for patients with multiple myeloma and as a monotherapy for patients with relapsed and/or refractory diffuse large B cell lymphoma. In this Review, we summarize the progress and challenges in the development of nuclear export inhibitors and discuss the potential of emerging combination therapies and biomarkers of response.
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MESH Headings
- Antineoplastic Agents/therapeutic use
- Cell Line, Tumor
- Dexamethasone/therapeutic use
- Drug Resistance, Neoplasm/genetics
- Hematologic Neoplasms/drug therapy
- Hematologic Neoplasms/genetics
- Hematologic Neoplasms/pathology
- Humans
- Hydrazines/therapeutic use
- Karyopherins/antagonists & inhibitors
- Karyopherins/genetics
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Molecular Targeted Therapy
- Receptors, Cytoplasmic and Nuclear/antagonists & inhibitors
- Receptors, Cytoplasmic and Nuclear/genetics
- Triazoles/therapeutic use
- Exportin 1 Protein
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Affiliation(s)
- Asfar S Azmi
- Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Mohammed H Uddin
- Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ramzi M Mohammad
- Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA.
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29
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Singh S, Singh K. Atherosclerosis, Ischemia, and Anticancer Drugs. Heart Views 2021; 22:127-133. [PMID: 34584624 PMCID: PMC8445146 DOI: 10.4103/heartviews.heartviews_45_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/30/2021] [Indexed: 11/04/2022] Open
Abstract
The heart is affected by cardiotoxicity of anticancer drugs. Myocardium, pericardium and endocardium can be affected. Besides these coronary arteries can be affected by accelerated atherosclerosis. Various pathogenic mechanisms have been proposed that underlie the ischemic complications of anticancer drugs. In this review we discuss the atherosclerotic and ischemic complications of anticancer drugs.
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Affiliation(s)
- Shailesh Singh
- Department of Cardiology, Fortis Escorts Heart Institute, New Delhi, India,Address for correspondence: Dr. Shailesh Singh, M-429, Ashiana Colony, Lucknow - 226 012, Uttar Pradesh, India. E-mail:
| | - Katyayni Singh
- Department of Paediatrics, Lal Bahadur Shastri Hospital, New Delhi, India
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30
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Moccia AA, Aeppli S, Güsewell S, Bargetzi M, Caspar C, Brülisauer D, Ebnöther M, Fehr M, Fischer N, Ghilardi G, Krasniqi F, Lang N, Mey U, Mingrone W, Novak U, Pfleger C, Richter P, Rütti M, Schmidt A, Stenner F, Voegeli M, Zander T, Zucca E, Hitz F. Clinical characteristics and outcome of patients over 60 years with Hodgkin lymphoma treated in Switzerland. Hematol Oncol 2020; 39:196-204. [PMID: 33300135 DOI: 10.1002/hon.2830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/06/2020] [Indexed: 11/09/2022]
Abstract
Hodgkin lymphoma (HL) in older patients appears to be a different disease compared with younger patients with historically lower survival rates. This is related to a variety of factors, including increased treatment-related toxicity, the presence of comorbidities, and biologic differences. In order to better assess the clinical characteristics, treatment strategies, and outcome of this particular population, we conducted a population-based, retrospective analysis including 269 patients with HL older than 60 years (median age 71 years, range 60-94), treated between 2000 and 2017 in 15 referral centers across Switzerland. Primary endpoints were overall survival (OS), progression-free survival (PFS), and cause-specific survival (CSS). The vast majority of patients were treated with curative intent, either with a combined modality approach (chemotherapy followed by radiation therapy) or with systemic therapy. At a median follow-up of 6.6 years (95% confidence interval [CI], 6.0-7.6), 5-year PFS was 52.2% (95% CI, 46.0-59.2), 5-year OS was 62.5% (95% CI, 56.4-69.2), and 5-year CSS was 85.1.8% (95% CI, 80.3-90.1) for the entire cohort. A significant difference in terms of CSS was observed for patients older than 71 years in comparison to patients aged 60-70 years (hazard ratio 2.6, 1.3-5.0, p = 0.005). Bleomycin-induced lung toxicity (BLT) was documented in 26 patients (17.7%) out of the 147 patients exposed to this compound and was more frequent in patients older than 71 years (15/60, 25%). Outcome of HL pts older than 71 years appeared to decrease substantially in comparison to the younger counterpart. Treatment-related toxicities appeared to be relevant, in particular, BLT. New, potentially less toxic strategies need to be investigated in prospective clinical trials in this particular frail population.
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Affiliation(s)
- A A Moccia
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - S Aeppli
- Medical Oncology and Hematology Clinic, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - S Güsewell
- Clinical Trials Unit, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - M Bargetzi
- Hematology, Kantonsspital Aarau, Aarau, Switzerland
| | - C Caspar
- Medical Oncology and Hematology, Kantonsspital Baden, Baden, Switzerland
| | - D Brülisauer
- Medical Oncology Clinic, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - M Ebnöther
- Medical Oncology and Hematology, Claraspital, Basel, Switzerland
| | - M Fehr
- Medical Oncology and Hematology Clinic, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - N Fischer
- Medical Oncology and Hematology Clinic, Kantonsspital Winterthur, Winterthur, Switzerland
| | - G Ghilardi
- Hematology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - F Krasniqi
- Medical Oncology Clinic, University Hospital of Basel, Basel, Switzerland
| | - N Lang
- Medical Oncology Clinic, University Hospital of Geneva, Genève, Switzerland
| | - U Mey
- Medical Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland
| | - W Mingrone
- Medical Oncology Clinic, Kantonsspital Olten, Olten, Switzerland
| | - U Novak
- Medical Oncology Clinic, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - C Pfleger
- Medical Oncology and Hematology, Claraspital, Basel, Switzerland
| | - P Richter
- Medical Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland
| | - M Rütti
- Internal Medicine Clinic, Spital Wil, Wil, Switzerland
| | - A Schmidt
- Medical Oncology and Hematology Clinic, Stadtspital Triemli, Zürich, Switzerland
| | - F Stenner
- Medical Oncology Clinic, University Hospital of Basel, Basel, Switzerland
| | - M Voegeli
- Medical Oncology and Hematology Clinic, Kantonsspital Baselland, Liestal, Switzerland
| | - T Zander
- Medical Oncology, Luzerner Kantonsspital, Luzern, Switzerland
| | - E Zucca
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - F Hitz
- Medical Oncology and Hematology Clinic, Kantonsspital St. Gallen, St. Gallen, Switzerland
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31
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Raymakers AJN, Costa S, Cameron D, Regier DA. Cost-effectiveness of brentuximab vedotin in advanced stage Hodgkin's lymphoma: a probabilistic analysis. BMC Cancer 2020; 20:992. [PMID: 33050897 PMCID: PMC7557030 DOI: 10.1186/s12885-020-07374-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 09/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) is a well-established therapy for advanced Hodgkin's lymphoma (HL). However, the recently completed ECHELON-1 trial showed potential net clinical benefit for brentuximab vedotin (BREN+AVD) compared to ABVD as frontline therapy in patients with advanced Hodgkin's lymphoma. The objective of this analysis is to determine whether, on current evidence, BREN+AVD is cost-effective relative to ABVD as frontline therapy in patients with advanced HL. METHODS We constructed a probabilistic Markov model with two arms and six mutually exclusive health states, using six-month cycle lengths, and a 15-year time horizon. Time-dependent transition probabilities were calculated from 'real-world' data collected by the BC Cancer's Centre for Lymphoid Cancer database or from the literature for ABVD. Time-dependent transition probabilities for BREN+AVD were taken from the ECHELON-1 trial. We estimated the incremental cost and effects per patient of each therapy and calculated the incremental cost-effectiveness ratio (ICER). Costs were measured in 2018 Canadian dollars and effects measured in quality-adjusted life years (QALYs). A probabilistic analysis was used to generate a cost-effectiveness acceptability curve (CEAC). RESULTS The incremental cost between standard therapy with ABVD and therapy with BREN+AVD was estimated to be $192,336. The regimen of BREN+AVD resulted in a small benefit in terms of QALYs (0.46 QALYs). The estimated ICER was $418,122 per QALY gained. The probabilistic analysis suggests very few (8%) simulations fall below $100,000 per QALY. Even at a threshold of $200,000 per QALY gained, there was only a 24% chance that BREN+AVD would be considered cost-effective. Sensitivity analyses evaluating price reductions for brentuximab showed that these reductions needed to be in excess of 70% for this regimen to be cost-effective at a threshold of $100,000 per QALY. CONCLUSIONS There may be a clinical benefit associated with BREN+AVD, but on current evidence the benefit is not adequately substantive compared to ABVD therapy given the cost of brentuximab vedotin. Agencies responsible for making decisions about BREN+AVD as frontline therapy for patients with advanced HL should consider whether they are willing to implement this treatment given the current uncertainty and cost-benefit profile, or negotiate substantial price-reductions from the manufacturer should they choose to reimburse.
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Affiliation(s)
- A J N Raymakers
- Health Economics Analytic Support and Research Unit (HEASRU), BC Cancer, Vancouver, Canada.
- Canadian Centre for Applied Research in Cancer Control (ARCC), BC Cancer Research Centre, 2nd floor, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
| | - S Costa
- Canadian Centre for Applied Research in Cancer Control (ARCC), BC Cancer Research Centre, 2nd floor, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada
| | - D Cameron
- Health Economics Analytic Support and Research Unit (HEASRU), BC Cancer, Vancouver, Canada
- Canadian Centre for Applied Research in Cancer Control (ARCC), BC Cancer Research Centre, 2nd floor, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada
| | - D A Regier
- Health Economics Analytic Support and Research Unit (HEASRU), BC Cancer, Vancouver, Canada
- Canadian Centre for Applied Research in Cancer Control (ARCC), BC Cancer Research Centre, 2nd floor, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Stefoni V, Marangon M, Re A, Lleshi A, Bonfichi M, Pinto A, Bianchetti N, Pellegrini C, Argnani L, Zinzani PL. Brentuximab vedotin in the treatment of elderly Hodgkin lymphoma patients at first relapse or with primary refractory disease: a phase II study of FIL ONLUS. Haematologica 2020; 105:e512. [PMID: 33054094 PMCID: PMC7556670 DOI: 10.3324/haematol.2019.243170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Vittorio Stefoni
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, Bologna
| | - Miriam Marangon
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, Bologna
| | - Alessandro Re
- Department of Hematology, ASST Spedali Civili di Brescia, Brescia
| | | | | | - Antonello Pinto
- Hematology-Oncology and Stem Cell Transplantation Unit, National Cancer Institute, Fondazione Pascale, IRCCS, Napoli, Italy
| | | | - Cinzia Pellegrini
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, Bologna
| | - Lisa Argnani
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, Bologna
| | - Pier Luigi Zinzani
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, Bologna
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Cheson BD, Bartlett NL, LaPlant B, Lee HJ, Advani RJ, Christian B, Diefenbach CS, Feldman TA, Ansell SM. Brentuximab vedotin plus nivolumab as first-line therapy in older or chemotherapy-ineligible patients with Hodgkin lymphoma (ACCRU): a multicentre, single-arm, phase 2 trial. LANCET HAEMATOLOGY 2020; 7:e808-e815. [PMID: 33010817 DOI: 10.1016/s2352-3026(20)30275-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hodgkin lymphoma is potentially curable. However, 15-35% of older patients (ie, >60 years) have a lower response rate, worse survival outcomes, and greater toxicity than younger patients. Brentuximab vedotin and nivolumab exhibit activity in patients with relapsed or refractory Hodgkin lymphoma. We therefore aimed to evaluate the safety and efficacy of brentuximab vedotin and nivolumab in untreated older patients with Hodgkin lymphoma or in younger patients considered unsuitable for standard ABVD (ie, doxorubicin, bleomycin, vinblastine, and dacarbazine) therapy. METHODS We did a multicentre, single-arm, phase 2 trial at eight cancer centres in the USA. Previously untreated patients with classic Hodgkin lymphoma were eligible for study enrolment if they were 60 years or older, or younger than 60 years but considered unsuitable for standard chemotherapy because of a cardiac ejection fraction of less than 50%, pulmonary diffusion capacity of less than 80%, or a creatinine clearance of 30 mL/min or more but less than 60 mL/min, or those who refused chemotherapy. Patients were also required to have an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2. Patients received brentuximab vedotin at 1·8 mg/kg (dose cap at 180 mg) and nivolumab at 3 mg/kg both intravenously every 21 days for 8 cycles. The primary endpoint was the overall response, defined as a partial metabolic response or complete metabolic response at the end of 8 cycles of treatment. A per protocol analysis was done including all patients who received treatment in the activity and safety analyses. This study is registered with ClinicalTrials.gov, number NCT02758717. FINDINGS Between May 13, 2016, and Jan 30, 2019, the study accrued 46 patients. The median age was 71·5 years (IQR 64-77), with two (4%) of 46 patients younger than 60 years. Median follow-up was 21·2 months (IQR 15·6-29·9), and 35 (76%) of 46 patients completed all 8 cycles of therapy. At the interim analysis on Oct 11, 2019, the first 25 evaluable patients had an overall response rate of 64% ([95% CI 43-82] 16 of 25 patients; 13 [52%] had a complete metabolic response and three [12%] had a partial metabolic response). The trial was closed to accrual on Oct 14, 2019, after the interim analysis failed to meet the predefined criteria. In all 46 evaluable patients, 22 (48%) patients achieved a complete metabolic response and six (13%) achieved a partial metabolic response (overall response rate 61% [95% CI 45-75]). 14 (30%) of 46 patients had 16 dose adjustments, primarily due to neurotoxicity. 22 (48%) of 46 patients had peripheral neuropathy (five [11%] patients had grade 3 peripheral neuropathy). Grade 4 adverse events included increased aminotranferases (one [2%] of 46), increased lipase or amylase (two [4%]), and pancreatitis (one [2%]). One (2%) patient died from cardiac arrest, possibly treatment related. INTERPRETATION Although the trial did not meet the prespecified activity criteria, brentuximab vedotin plus nivolumab is active in older patients with previously untreated Hodgkin lymphoma with comorbidities. The regimen was also well tolerated in the majority of patients in this older population. Future trials should be based on optimising the dose and schedule, perhaps combined with other targeted agents that might permit chemotherapy-free strategies in older patients with Hodgkin lymphoma. FUNDING Seattle Genetics and Bristol Myers Squibb.
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Affiliation(s)
| | - Nancy L Bartlett
- Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA
| | - Betsy LaPlant
- Division of Biomedical Statistics and Bioinformatics, Department of Health Sciences Research, Mayo Clinic Rochester, Rochester, MN, USA
| | - Hun J Lee
- Department of Lymphoma and Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Beth Christian
- Hematology Division, Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Catherine S Diefenbach
- Clinical Lymphoma Program, Perlmutter Cancer Center at NYU Langone Health, New York, NY, USA
| | - Tatyana A Feldman
- Lymphoma Division, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Stephen M Ansell
- Division of Medical Oncology, Department of Medicine, Mayo Clinic Rochester, Rochester, MN, USA
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Percival MEM, Lynch RC, Halpern AB, Shadman M, Cassaday RD, Ujjani C, Shustov A, Tseng YD, Liu C, Pergam S, Libby EN, Scott BL, Smith SD, Green DJ, Gopal AK, Cowan AJ. Considerations for Managing Patients With Hematologic Malignancy During the COVID-19 Pandemic: The Seattle Strategy. JCO Oncol Pract 2020; 16:571-578. [PMID: 32369409 PMCID: PMC7489485 DOI: 10.1200/op.20.00241] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2020] [Indexed: 02/07/2023] Open
Abstract
In January 2020, the first documented patient in the United States infected with severe acute respiratory syndrome coronavirus 2 was diagnosed in Washington State. Since that time, community spread of coronavirus disease 2019 (COVID-19) in the state has changed the practice of oncologic care at our comprehensive cancer center in Seattle. At the Seattle Cancer Care Alliance, the primary oncology clinic for the University of Washington/Fred Hutchinson Cancer Consortium, our specialists who manage adult patients with hematologic malignancies have rapidly adjusted clinical practices to mitigate the potential risks of COVID-19 to our patients. We suggest that our general management decisions and modifications in Seattle are broadly applicable to patients with hematologic malignancies. Despite a rapidly changing environment that necessitates opinion-based care, we provide recommendations that are based on best available data from clinical trials and collective knowledge of disease states.
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Affiliation(s)
- Mary-Elizabeth M. Percival
- Seattle Cancer Care Alliance, Seattle, WA
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ryan C. Lynch
- Seattle Cancer Care Alliance, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Anna B. Halpern
- Seattle Cancer Care Alliance, Seattle, WA
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Mazyar Shadman
- Seattle Cancer Care Alliance, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Ryan D. Cassaday
- Seattle Cancer Care Alliance, Seattle, WA
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Chaitra Ujjani
- Seattle Cancer Care Alliance, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Andrei Shustov
- Seattle Cancer Care Alliance, Seattle, WA
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Yolanda D. Tseng
- Seattle Cancer Care Alliance, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - Catherine Liu
- Seattle Cancer Care Alliance, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Steven Pergam
- Seattle Cancer Care Alliance, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Edward N. Libby
- Seattle Cancer Care Alliance, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Bart L. Scott
- Seattle Cancer Care Alliance, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Stephen D. Smith
- Seattle Cancer Care Alliance, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Damian J. Green
- Seattle Cancer Care Alliance, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Ajay K. Gopal
- Seattle Cancer Care Alliance, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Andrew J. Cowan
- Seattle Cancer Care Alliance, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
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Dalal M, Gupta J, Price K, Zomas A, Miao H, Ashaye A. Efficacy and safety of front-line treatments for advanced Hodgkin lymphoma: a systematic literature review. Expert Rev Hematol 2020; 13:907-922. [PMID: 32749937 DOI: 10.1080/17474086.2020.1793666] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess evidence on the safety and efficacy of ABVD (doxorubicin [Adriamycin®], bleomycin, vinblastine, and dacarbazine), BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone), and A+AVD (brentuximab vedotin, with doxorubicin, vinblastine, and dacarbazine) for advanced-stage Hodgkin lymphoma (HL). METHODS A systematic literature review (SLR) was conducted on 29 July 2016 (updated 26 July 2018) to identify randomized controlled trials (RCTs) and non-RCTs assessing the treatment of newly-diagnosed advanced-stage HL with ABVD and BEACOPP (and their variants), and A+AVD. RESULTS The SLR identified 62 RCTs and 42 non-RCTs. Five-year overall survival rates for ABVD and BEACOPP were 60-97% and 84-99%, and 5-year progression-free survival rates were 58-81% and 83-96%, respectively. Both regimens were associated with tolerability issues and side effects. Discontinuation or dose reduction of bleomycin resulted in fewer adverse events, without significantly affecting efficacy. A head-to-head trial demonstrated improved efficacy for A+AVD vs ABVD, with an acceptable tolerability profile. No data from head-to-head trials comparing A+AVD with BEACOPP were available, and an indirect treatment comparison was not feasible. CONCLUSION New therapies, such as A+AVD, maintain the efficacy observed with current treatments, and may provide a more tolerable treatment option for patients with advanced-stage HL.
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Affiliation(s)
- Mehul Dalal
- Global Evidence & Outcomes - Oncology, Millennium Pharmaceuticals, Inc. a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , Cambridge, MA, USA
| | - Jatin Gupta
- Global Access, Decision Resources Group , Gurugram, Haryana, 122002, India
| | - Kim Price
- Global Access, Decision Resources Group, 6 Talisman Business Centre, Bicester , Oxfordshire, USA
| | - Athanasios Zomas
- Global Medical Affairs - Oncology, Millennium Pharmaceuticals, Inc. a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Harry Miao
- Clinical Sciences , Millennium Pharmaceuticals, Inc. a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Ajibade Ashaye
- Global Evidence & Outcomes - Oncology, Millennium Pharmaceuticals, Inc. a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , Cambridge, MA, USA
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Nikolaenko L, Nademanee A. Brentuximab vedotin and its use in the treatment of advanced Hodgkin's lymphoma. Future Oncol 2020; 16:2273-2282. [PMID: 32677451 DOI: 10.2217/fon-2020-0026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Brentuximab vedotin (BV), a CD30-directed antibody-drug conjugate, is US FDA approved for treatment of classic Hodgkin lymphoma (cHL) after progression or relapse of at least two prior lines of chemotherapy or autologous stem cell transplantation, as consolidation therapy after autologous stem cell transplantation for high-risk patients and as a front-line therapy for previously untreated, advanced-stage cHL in combination with chemotherapy. BV is a well-tolerated treatment in previously heavily pretreated relapsed/refractory cHL and in treatment-naive patients. BV use, in combination with other antineoplastic agents for cHL, is under investigation in multiple prospective clinical trials.
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Affiliation(s)
- Liana Nikolaenko
- Department of Hematology/Bone Marrow Transplant, City of Hope, Duarte, CA 91010, USA
| | - Auayporn Nademanee
- Department of Hematology/Bone Marrow Transplant, City of Hope, Duarte, CA 91010, USA
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Rodday AM, Hahn T, Kumar AJ, Lindenauer PK, Friedberg JW, Evens AM, Parsons SK. First-line treatment in older patients with Hodgkin lymphoma: a Surveillance, Epidemiology, and End Results (SEER)-Medicare population-based study. Br J Haematol 2020; 190:222-235. [PMID: 32090325 PMCID: PMC7368808 DOI: 10.1111/bjh.16525] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/14/2020] [Indexed: 11/26/2022]
Abstract
While Hodgkin lymphoma (HL) is highly curable in younger patients, older patients have higher relapse and death rates, which may reflect age-related factors, distinct disease biology and/or treatment decisions. We described the association between patient, disease and geographic factors and first-line treatment in older patients (≥65 years) with incident HL using Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 1999 to 2014 (n = 2825). First-line treatment initiated at ≤4 months after diagnosis was categorised as: full chemotherapy regimen (n = 699, 24·7%); partial chemotherapy regimen (n = 1016, 36·0%); single chemotherapy agent or radiotherapy (n = 382, 13·5%); and no treatment (n = 728, 25·8%). Among the fully treated, ABVD [doxorubicin (Adriamycin), bleomycin, vinblastine, dacarbazine]/AVD was most common (n = 635, 90·8%). Adjusted multinomial logistic regression identified factors associated with treatment. Older age, Medicaid dual eligibility, not married, frailty, cardiac comorbidity, prior cancer, earlier diagnosis date, histology, advanced disease Stage, B symptoms and South region were independently associated with increased odds of not receiving full chemotherapy regimens. In conclusion, we found variability in first-line HL treatment for older patients. Treatment differences by Medicaid and region may indicate disparities. Even after adjusting for frailty and cardiac comorbidity, age was associated with treatment, suggesting factors such as end-of-life care or shared decision-making may influence treatment in older patients.
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Affiliation(s)
- Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
| | - Theresa Hahn
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Anita J. Kumar
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
| | - Peter K. Lindenauer
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School - Baystate, Springfield, MA
| | | | - Andrew M. Evens
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Susan K. Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
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Makita S, Maruyama D, Tobinai K. Safety and Efficacy of Brentuximab Vedotin in the Treatment of Classic Hodgkin Lymphoma. Onco Targets Ther 2020; 13:5993-6009. [PMID: 32606807 PMCID: PMC7320890 DOI: 10.2147/ott.s193951] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 06/11/2020] [Indexed: 01/01/2023] Open
Abstract
Classical Hodgkin lymphoma (cHL) is a B-cell-derived lymphoid malignancy with the most favorable prognosis among various adult malignancies. However, once it becomes refractory disease to chemotherapy or relapses after high-dose chemotherapy (HDC) with autologous stem cell transplantation (ASCT), it is difficult to manage with conventional cytotoxic chemotherapy. The introduction of brentuximab vedotin (BV) has changed the treatment landscape of cHL in the past decade. Several studies demonstrated high efficacy of BV monotherapy in heavily treated patients with cHL relapsed or refractory after HDC/ASCT. Recent studies also reported high efficacy of concurrent or sequential combination of BV and chemotherapy in patients with transplant-eligible relapsed/refractory cHL at the second-line setting. In addition, a randomized phase III trial ECHELON-1 reported a positive result of BV in combination with AVD (doxorubicin, vinblastine, and dacarbazine) in patients with newly diagnosed advanced-stage cHL. In this review, we summarize available data of BV for cHL and discuss the current and future role of BV in the management of cHL.
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Affiliation(s)
- Shinichi Makita
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Dai Maruyama
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Kensei Tobinai
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
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Rusconi C, Ciavarella S, Fabbri A, Flenghi L, Puccini B, Re A, Sorio M, Vanazzi A, Zanni M. Treatment of very high-risk classical Hodgkin Lymphoma: cases' selection from real life and critical review of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:13-22. [PMID: 32525130 PMCID: PMC7944652 DOI: 10.23750/abm.v91is-5.9911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 11/25/2022]
Abstract
Over the last 4 decades, advances in radiation therapy and the addition of combination chemotherapy have significantly increased the cure rate of patients with HL, with a 5-year OS of about 90% . However, despite high rate of cure after first line of therapy, 5%-10% of HLs are refractory to the treatment, and 10-30% of patients have a disease relapse after a complete response (CR). Relapsed HL can be treated with salvage therapies with a long-lasting complete remission in 80% of cases. In recent years, novel drugs are available for the patients with relapsed/refractory HL, like Brentuximab Vedotin and immune checkpoint inhibitors. These drugs have been able to rescue a cohort of patients who subsequently could receive an allogeneic stem-cell transplant. Our cases have been chosen because they are representative of critical issues in the management of relapsed/refractory HL; our experiences are consistent with what reported by other Authors.
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Affiliation(s)
- Chiara Rusconi
- Division of Haematology, Department of Haematology and Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano.
| | - Sabino Ciavarella
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy.
| | - Alberto Fabbri
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy.
| | | | - Benedetta Puccini
- Haematology Unit, Careggi Hospital-University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Alessandro Re
- Department of Hematology, ASST Spedali Civili di Brescia, Italy.
| | - Marco Sorio
- Department of Clinical and Experimental Medicine, Hematology and Bone Marrow Transplant Unit, University of Verona, Verona, Italy.
| | - Anna Vanazzi
- Division of Clinical Hemato-Oncology, Istituto Europeo di Oncologia, Milan, Italy.
| | - Manuela Zanni
- Hematology Unit, Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy.
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40
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Carter J, David KA, Kritharis A, Evens AM. Current Treatment Options for Older Patients with Hodgkin Lymphoma. Curr Treat Options Oncol 2020; 21:42. [PMID: 32328822 DOI: 10.1007/s11864-020-00745-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OPINION STATEMENT Older adults with Hodgkin lymphoma (HL), commonly defined as age ≥ 60 years, represent approximately 20% of the total HL population. Historically, they have significantly inferior outcomes compared with younger patients. The cause of this is multifactorial, including biologic differences (e.g., mixed cellularity and EBV-related disease); high incidence of advanced stage disease; and frequency of comorbidities and decreased organ reserve leading to poorer tolerability of therapy with increased toxicity, including treatment-related mortality. Pretreatment evaluation for older HL patients should entail a geriatric assessment (GA), with evaluation of functional status and comorbidities (e.g., geriatric cumulative illness rating scale, CIRS-G) to determine fitness. Furthermore, treatment selection should be based in part on GA, with fit older patients receiving curative chemotherapy-based regimens and unfit or frail patients considering less intensive or non-chemotherapy-based platforms. Additionally, there may be consideration for pre-phase of therapy (e.g., pulse steroids) in order to improve performance status. The inclusion of anthracycline therapy appears important, while bleomycin-containing regimens (e.g., ABVD) may be associated with prohibitive pulmonary toxicity, and intensive therapies such as BEACOPP are too toxic. benefit ratio/benefit ratio, a priori omission of bleomycin may also be considered (i.e., AVD), especially for patients older than 70 years of age. In addition, newer regimens for older HL patients integrating novel therapeutic agents into frontline treatment have emerged as effective and tolerable options. Data incorporating brentuximab vedotin sequentially before and after AVD chemotherapy represent the best-reported outcomes in older HL patients to date. In the relapsed/refractory setting, salvage chemotherapy regimens followed by autologous stem cell transplantation should be considered for fit patients, while less intensive treatment, including the use of novel targeted agents, is an option for unfit or frail patients. In this review, we examine the epidemiology, importance of GA, and current treatment options for older HL patients.
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Affiliation(s)
- Jordan Carter
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA
| | - Kevin A David
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA
| | - Athena Kritharis
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA
| | - Andrew M Evens
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA.
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Barreca M, Stathis A, Barraja P, Bertoni F. An overview on anti-tubulin agents for the treatment of lymphoma patients. Pharmacol Ther 2020; 211:107552. [PMID: 32305312 DOI: 10.1016/j.pharmthera.2020.107552] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/14/2020] [Indexed: 01/19/2023]
Abstract
Anti-tubulin agents constitute a large class of compounds with broad activity both in solid tumors and hematologic malignancies, due to the interference with microtubule dynamics. Since microtubules play crucial roles in the regulation of the mitotic spindles, the interference with their function usually leads to a block in cell division with arrest at the metaphase/anaphase junction of mitosis, followed to apoptosis. This explains the reason why tubulin-binding agents (TBAs) proved to be extremely active in patients with cancer. Several anti-tubulin agents are indicated in the treatment of patients with lymphomas both alone and in combination chemotherapy regimens. The article reviews the literature on classic and more recent anti-tubulin agents, providing an insight into their mechanisms of action and their use in the treatment of lymphoma.
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Affiliation(s)
- Marilia Barreca
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Palermo, Italy; Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland,; Faculty of Biomedical Sciences, USI, Lugano, Switzerland
| | - Paola Barraja
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Palermo, Italy
| | - Francesco Bertoni
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland,; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland,.
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Sykorova A, Mocikova H, Lukasova M, Koren J, Stepankova P, Prochazka V, Belada D, Klaskova K, Gaherova L, Chroust K, Buresova L, Markova J. Outcome of elderly patients with classical Hodgkin’s lymphoma. Leuk Res 2020; 90:106311. [DOI: 10.1016/j.leukres.2020.106311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 01/18/2020] [Accepted: 01/22/2020] [Indexed: 11/27/2022]
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Allen PB, Ayers A, Behera M, Evens AM, Flowers C. A systematic review of therapeutic regimens for older patients with newly diagnosed Hodgkin lymphoma. Leuk Lymphoma 2020; 61:1555-1564. [PMID: 32102579 DOI: 10.1080/10428194.2020.1731497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Classical Hodgkin lymphoma (cHL) in older adults is associated with inferior outcomes and increased toxicity compared to younger patients. Novel therapies like brentuximab vedotin (BV) have yielded promising results, yet their optimal use in older cHL remains unclear. We performed a systematic review to assess outcomes and toxicity associated with frontline regimens in older cHL. We screened 196 references involving chemotherapy without BV and 662 references containing BV and included 9 studies (12 arms) without BV and 6 studies (7 arms) with BV. Progression-free survival (PFS) ranged from 47 to 84% at 2 years in BV-containing arms and 42-79% at 5 years in non-BV containing trials. Pulmonary toxicity was more common in arms receiving >2 cycles of bleomycin, whereas peripheral neuropathy was associated with cumulative BV dose. This review summarizes available treatment outcomes in newly diagnosed older cHL patients and may aid clinicians in decision-making regarding available frontline approaches.Key PointsThis systematic review suggests that >2 cycles of bleomycin is associated with excess pulmonary toxicity in cHL patients older than 60 years of age.Peripheral neuropathy was more frequent in patients receiving BV-containing regimens and was associated with cumulative BV dose.BV-containing regimens are associated with high response rates in advanced-stage patients, but follow-up is limited.
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Affiliation(s)
- Pamela B Allen
- Department of Hematology and Oncology, Winship Cancer Institution of Emory University, Atlanta, GA, USA
| | - Amy Ayers
- Department of Hematology and Oncology, Winship Cancer Institution of Emory University, Atlanta, GA, USA
| | - Madhusmita Behera
- Department of Research Informatics, Winship Cancer Institution of Emory University, Atlanta, GA, USA
| | - Andrew M Evens
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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Evens AM, Carter J, Loh KP, David KA. Management of older Hodgkin lymphoma patients. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:233-242. [PMID: 31808898 PMCID: PMC6913478 DOI: 10.1182/hematology.2019000028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Hodgkin lymphoma (HL) in older patients, commonly defined as ≥60 years of age, is a disease for which survival rates have historically been significantly lower compared with younger patients. Older HL patients appear to have different disease biology compared with younger patients, including increased incidence of mixed cellularity histology, Epstein-Barr virus-related, and advanced-stage disease. For prognostication, several studies have documented the significance of comorbidities and functional status in older HL patients, as well as the importance of achieving initial complete remission. Collectively, selection of therapy for older HL patients should be based in part on functional status, including pretreatment assessment of activities of daily living (ADL), comorbidities, and other geriatric measures (eg, cognition, social support). Treatment of fit older HL patients should be given with curative intent, regardless of disease stage. However, attention should be paid to serious treatment-related toxicities, including risk of treatment-related mortality. Although inclusion of anthracycline therapy is important, bleomycin-containing regimens (eg, doxorubicin, bleomycin, vinblastine, dacarbazine) may lead to prohibitive pulmonary toxicity, and intensive therapies (eg, bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) are too toxic. Brentuximab vedotin given sequentially before and after doxorubicin, vinblastine, and dacarbazine to fit, untreated advanced-stage older HL patients was recently shown to be tolerable and highly effective. Therapy for patients who are unfit or frail because of comorbidities and/or ADL loss is less clear and should be individualized with consideration of lower-intensity therapy, such as brentuximab vedotin with or without dacarbazine. Altogether, therapy for older HL patients should be tailored based upon a geriatric assessment, and novel targeted agents should continue to be integrated into treatment paradigms.
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Affiliation(s)
- Andrew M Evens
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and
| | - Jordan Carter
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and
| | - Kah Poh Loh
- Division of Hematology and Oncology, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Kevin A David
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and
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Advancing age and the risk of bleomycin pulmonary toxicity in a largely older cohort of patients with newly diagnosed Hodgkin Lymphoma. J Geriatr Oncol 2019; 11:69-74. [PMID: 31668826 DOI: 10.1016/j.jgo.2019.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/05/2019] [Accepted: 09/30/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVES In patients with Hodgkin Lymphoma (HL), the relationship between increasing age and bleomycin pulmonary toxicity (BPT) remains unclear. This study explores associations between age and BPT in a real-world cohort of largely older patients with HL. MATERIAL AND METHODS This study retrospectively evaluated a nationwide patient cohort of United States Veterans diagnosed with HL in VA medical centers between October 1, 2002 and December 31, 2013 (follow up through April 15, 2016). The primary outcome was the development BPT, defined as: ambient air oxygen saturations <92% with pulmonary infiltrates on chest radiograph and no other etiologies OR clinician documentation of BPT. Multivariable logistic regression was used to evaluate variables associated with development of BPT. Cox proportional hazards analysis was performed to evaluate the risk of death up-to 5-years from diagnosis. RESULTS Overall, 847 patients received chemotherapy and 739 of these patients received bleomycin. Sixty-six patients (9.3%) developed BPT. The incidence of BPT per age category: 0.03 (9/262), 0.07 (13/188), 0.13 (23/171), and 0.24 (21/88) for age categories: ≤ 49, 50-59, 60-69 and ≥ 70 years. Odds of BPT steadily increased with advancing age (compared to patients age ≤ 49 years) with odds ratios of 1.65 (95% CI 0.68-4.03), 3.24 (1.43-7.34), 6.01(2.52-7.34) for age categories 50-59, 60-69 and ≥ 70 years, respectively. The was no association between bleomycin and risk of death up-to 5-years [HR: 0.87; 95% CI (0.61-1.23)]. CONCLUSION This study demonstrates a direct relationship between age >60 years and odds of developing clinically significant BPT.
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Martinez-Cabriales SA, Walsh S, Sade S, Shear NH. Lymphomatoid papulosis: an update and review. J Eur Acad Dermatol Venereol 2019; 34:59-73. [PMID: 31494989 DOI: 10.1111/jdv.15931] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 08/08/2019] [Indexed: 12/13/2022]
Abstract
Lymphomatoid papulosis (LyP) is a benign chronic often relapsing skin condition that belongs to the CD30-positive cutaneous lymphoproliferative disorders. LyP typically presents as crops of lesions with a tendency to self-resolve, and morphology can range from solitary to agminated or diffuse papules and plaques to nodules or tumours. The clinical-histological spectrum can range from borderline cases to overlap with primary cutaneous anaplastic cell lymphoma (pcALCL). Histology and immunophenotype commonly show overlap with other CD30-positive disorders and sometimes may be identical to pcALCL, making its diagnosis more difficult. Patients with LyP have an increased risk of developing a second neoplasm such as mycosis fungoides, pcALCL and/or Hodgkin lymphoma. Clinical correlation allows its proper classification and diagnosis, which is fundamental for treatment and prognosis. This review focuses on the clinical appearance, histopathological features, diagnosis, differential diagnosis and management of LyP.
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Affiliation(s)
- S A Martinez-Cabriales
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Dermatology, Autonomous University of Nuevo Leon, San Nicolas de los Garza, Mexico
| | - S Walsh
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - S Sade
- Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - N H Shear
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Vassilakopoulos TP, Chatzidimitriou C, Asimakopoulos JV, Arapaki M, Tzoras E, Angelopoulou MK, Konstantopoulos K. Immunotherapy in Hodgkin Lymphoma: Present Status and Future Strategies. Cancers (Basel) 2019; 11:E1071. [PMID: 31362369 PMCID: PMC6721364 DOI: 10.3390/cancers11081071] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 12/17/2022] Open
Abstract
Although classical Hodgkin lymphoma (cHL) is usually curable, 20-30% of the patients experience treatment failure and most of them are typically treated with salvage chemotherapy and autologous stem cell transplantation (autoSCT). However, 45-55% of that subset further relapse or progress despite intensive treatment. At the advanced stage of the disease course, recently developed immunotherapeutic approaches have provided very promising results with prolonged remissions or disease stabilization in many patients. Brentuximab vedotin (BV) has been approved for patients with relapsed/refractory cHL (rr-cHL) who have failed autoSCT, as a consolidation after autoSCT in high-risk patients, as well as for patients who are ineligible for autoSCT or multiagent chemotherapy who have failed ≥ two treatment lines. However, except of the consolidation setting, 90-95% of the patients will progress and require further treatment. In this clinical setting, immune checkpoint inhibitors (CPIs) have produced impressive results. Both nivolumab and pembrolizumab have been approved for rr-cHL after autoSCT and BV failure, while pembrolizumab has also been licensed for transplant ineligible patients after BV failure. Other CPIs, sintilimab and tislelizumab, have been successfully tested in China, albeit in less heavily pretreated populations. Recent data suggest that the efficacy of CPIs may be augmented by hypomethylating agents, such as decitabine. As a result of their success in heavily pretreated disease, BV and CPIs are moving to earlier lines of treatment. BV was recently licensed by the FDA for the first-line treatment of stage III/IV Hodgkin lymphoma (HL) in combination with AVD (only stage IV according to the European Medicines Agency (EMA)). CPIs are currently being evaluated in combination with AVD in phase II trials of first-line treatment. The impact of BV and CPIs was also investigated in the setting of second-line salvage therapy. Finally, combinations of targeted therapies are under evaluation. Based on these exciting results, it appears reasonable to predict that an improvement in survival and a potential increase in the cure rates of cHL will soon become evident.
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Affiliation(s)
- Theodoros P Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece.
| | - Chrysovalantou Chatzidimitriou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - John V Asimakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Maria Arapaki
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Evangelos Tzoras
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Maria K Angelopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Kostas Konstantopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
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48
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Vassilakopoulos TP, Chatzidimitriou C, Asimakopoulos JV, Arapaki M, Tzoras E, Angelopoulou MK, Konstantopoulos K. Immunotherapy in Hodgkin Lymphoma: Present Status and Future Strategies. Cancers (Basel) 2019. [PMID: 31362369 DOI: 10.3390/cancers] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Although classical Hodgkin lymphoma (cHL) is usually curable, 20-30% of the patients experience treatment failure and most of them are typically treated with salvage chemotherapy and autologous stem cell transplantation (autoSCT). However, 45-55% of that subset further relapse or progress despite intensive treatment. At the advanced stage of the disease course, recently developed immunotherapeutic approaches have provided very promising results with prolonged remissions or disease stabilization in many patients. Brentuximab vedotin (BV) has been approved for patients with relapsed/refractory cHL (rr-cHL) who have failed autoSCT, as a consolidation after autoSCT in high-risk patients, as well as for patients who are ineligible for autoSCT or multiagent chemotherapy who have failed ≥ two treatment lines. However, except of the consolidation setting, 90-95% of the patients will progress and require further treatment. In this clinical setting, immune checkpoint inhibitors (CPIs) have produced impressive results. Both nivolumab and pembrolizumab have been approved for rr-cHL after autoSCT and BV failure, while pembrolizumab has also been licensed for transplant ineligible patients after BV failure. Other CPIs, sintilimab and tislelizumab, have been successfully tested in China, albeit in less heavily pretreated populations. Recent data suggest that the efficacy of CPIs may be augmented by hypomethylating agents, such as decitabine. As a result of their success in heavily pretreated disease, BV and CPIs are moving to earlier lines of treatment. BV was recently licensed by the FDA for the first-line treatment of stage III/IV Hodgkin lymphoma (HL) in combination with AVD (only stage IV according to the European Medicines Agency (EMA)). CPIs are currently being evaluated in combination with AVD in phase II trials of first-line treatment. The impact of BV and CPIs was also investigated in the setting of second-line salvage therapy. Finally, combinations of targeted therapies are under evaluation. Based on these exciting results, it appears reasonable to predict that an improvement in survival and a potential increase in the cure rates of cHL will soon become evident.
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Affiliation(s)
- Theodoros P Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece.
| | - Chrysovalantou Chatzidimitriou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - John V Asimakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Maria Arapaki
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Evangelos Tzoras
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Maria K Angelopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Kostas Konstantopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
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Salvi F, Luminari S, Tucci A, Massidda S, Liberati AM, Stelitano C, Zanni M, Re A, Centurioni R, Freilone R, Musuraca G, Nassi L, Patti C, Arcari A, Tani M, Pulsoni A, Pavone V, Volpetti S, Peli A, Evangelista A, Spina M, Ladetto M, Merli F. Bleomycin, vinblastine and dacarbazine combined with nonpegylated liposomal doxorubicin (MBVD) in elderly (≥70 years) or cardiopathic patients with Hodgkin lymphoma: a phase-II study from Fondazione Italiana Linfomi (FIL). Leuk Lymphoma 2019; 60:2890-2898. [PMID: 31282794 DOI: 10.1080/10428194.2019.1608529] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This phase-II study assessed activity and toxicity of substituting conventional doxorubicin with nonpegylated liposomal doxorubicin in the conventional ABVD regimen for the treatment of elderly or cardiopathic patients with HL. Stage I-IIA and IIB-IV patients were treated with three courses of MBVD plus radiotherapy, or six courses of MBVD, respectively, plus radiotherapy limited to bulky or residual disease areas. The primary endpoints were CR rate and the rate of cardiac events. Forty-seven patients were enrolled. Median age was 75 years, 13 had stage I-II disease. Overall, CR was achieved by 36 patients (77%, 95% CI: 62-88), 100% and 68% in stage I-II and III-IV, respectively. With a median follow-up of 40 months (IQR: 36-45). Three-year overall survival (OS) and progression-free survival (PFS) were 70% and 43%, respectively. Cardiac events grades 3-5 were reported in two patients. In conclusion, MBVD's activity and safety profile was comparable to historical ABVD data.
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Affiliation(s)
- Flavia Salvi
- Division of Hematology, SS. Antonio e Biagio Hospital, Alessandria, Italy
| | - Stefano Luminari
- Hematology Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy.,Surgical, Medical and Dental Department of Morphological Sciences related to Transplant Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandra Tucci
- Division of Haematology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Stefania Massidda
- Hematology and Transplant Center, Ospedale Oncologico di Riferimento Regionale Armando Businco, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Anna Marina Liberati
- Oncohematology and autotransplantation Unit, Azienda Ospedaliera Santa Maria, Terni, Italy
| | - Caterina Stelitano
- Division of Hematology, Azienda Ospedaliera "Bianchi Melacrino Morelli", Reggio Calabria, Italy
| | - Manuela Zanni
- Division of Hematology, SS. Antonio e Biagio Hospital, Alessandria, Italy
| | - Alessandro Re
- Division of Haematology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Riccardo Centurioni
- Internal medicine and hematology Unit, Azienda Sanitaria Unica Regionale Marche AV3, Civitanova Marche, Italy
| | | | - Gerardo Musuraca
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Luca Nassi
- Division of Hematology Department of Translational Medicine, Università del Piemonte Orientale and AOU Maggiore della Carità, Novara, Italy
| | - Caterina Patti
- Department of Hematology I, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Annalisa Arcari
- Hematology Unit and Transplantion Center, "Guglielmo da Saliceto" Hospital, Piacenza, Italy
| | - Monica Tani
- Hematology, S. Maria delle Croci Hospital, Ravenna, Italy
| | - Alessandro Pulsoni
- Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I "Sapienza" University of Rome, Roma, Italy
| | - Vincenzo Pavone
- Department of Hematology and Bone Marrow Transplant, Hospital Card. G. Panico, Tricase, Italy
| | - Stefano Volpetti
- Department of Haematology, DISM Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Annalisa Peli
- Division of Haematology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Andrea Evangelista
- Clinical and Evaluative Epidemiology Unit, AOU Città della Salute e della Scienza di Torino e CPO Piemonte, Torino, Italy
| | - Michele Spina
- Division of Medical Oncology and Immunorelated Tumors, National Cancer Institute, Aviano, Italy
| | - Marco Ladetto
- Division of Hematology, SS. Antonio e Biagio Hospital, Alessandria, Italy
| | - Francesco Merli
- Hematology Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
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50
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Clifford K, Copeland A, Knutzen G, Samuelson E, Grove L, Schiavo K. Brentuximab Vedotin: A Nursing Perspective on Best Practices and Management of Associated Adverse Events. Clin J Oncol Nurs 2019; 22:E103-E114. [PMID: 30035778 DOI: 10.1188/18.cjon.e103-e114] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Brentuximab vedotin (BV) is an antibody-drug conjugate that targets CD30-expressing cells. OBJECTIVES This article assesses the occurrence and management of the most frequent and clinically relevant BV-associated adverse events (AEs), with a focus on Hodgkin lymphoma and systemic anaplastic large cell lymphoma trials, and shares practical tips that may help decrease occurrence and severity. METHODS Peer-reviewed literature was surveyed to collect safety data from sponsored clinical trials of BV and to compile associated management guidelines. FINDINGS Peripheral neuropathy was the most common BV-associated AE across clinical trials. Other clinically relevant AEs included neutropenia, infection, and infusion-related reactions. Awareness of and preparedness for these common BV-associated AEs and other less common but significant AEs will help nurse clinicians and patients maximize the clinical benefit for patients receiving BV.
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