Lymphoid Malignancy Treatment Considerations - Episode 8

Novel Agents and Combinations in Hodgkin Lymphoma

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HDAC inhibitors, such as panobinostat, have demonstrated some efficacy in patients with relapsed Hodgkin lymphoma, explains Anas Younes, MD. In the post-transplant setting, trials have demonstrated response rates in the range of 20-25%. Long term follow up of studies also demonstrated promising progression-free survival for patients treated with panobinostat versus placebo, warranting further investigation. Studies are now exploring panobinostat in combination with the ICE chemotherapy regimen in the pre-transplant setting, Younes notes.

Factors that predict response in patients with Hodgkin lymphoma are gaining further attention in large trials, in order to predict outcomes from therapy, notes Younes. Additionally, minimal residual disease (MRD) analyses could help guide adjuvant treatment selection and utilization, Younes adds. Intervention can be utilized early once MRD is detected, possibly putting the disease back into remission, notes Myron Czuczman, MD.

Traditionally, drugs that demonstrate efficacy in the relapsed setting are tested in the frontline, Younes notes. At this point, studies are exploring brentuximab vedotin in combination with AVD in comparison with ABVD. In earlier studies, the combination of brentuximab vedotin with bleomycin resulted in high-levels of lung toxicity, resulting in the combination with AVD rather than ABVD, Younes notes.

Large clinical studies are also exploring brentuximab vedotin in combination with CHP versus CHOP alone for patients with T cell lymphoma, notes Steven M. Horowitz, MD. This study omitted vincristine from the combination arm, since it is less active and to avoid toxicity.