Radhakrishnan Ramchandren, MD
The North American subgroup analysis of the phase III ECHELON-1 trial revealed more than double the improvement seen with brentuximab vedotin (Adcetris) plus doxorubicin, vinblastine, and dacarbazine (A+AVD) compared with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) versus the primary study findings in patients with advanced Hodgkin lymphoma, explained lead author Radhakrishnan Ramchandren, MD.
In the interview, Ramchandren, associate professor, Wayne State University School of Medicine, Karmanos Cancer Institute, gave an overview of the treatment landscape in Hodgkin and T-cell lymphoma before delving into the results of the North American subgroup analysis of the ECHELON-1 trial.
OncLive: Can you provide an overview of your lectures on Hodgkin lymphoma and T-cell lymphoma?
Hodgkin lymphoma is a disease that occurs in young individuals. It has been a landmark condition because we have historically had early success in treating it. However, this has come at the cost of toxicities—both acute and long-term—for patients who survive. There are patients who unfortunately don't respond to standard chemotherapy and radiation and relapse. For those patients, autologous stem cell transplant (ASCT) is an option. However, some of those patients can't achieve a remission and go to transplant or are unable to go to transplant for other reasons. For those individuals, expectations are very short in terms of lifespan and quality of life.
Improvements in therapy have been somewhat sluggish. That being said, in the past decade, there have been great advances in understanding the biology of this disease. The incorporation of novel agents has become more common, particularly in the relapsed setting. There have been studies looking at incorporating these agents in the frontline setting as well. We are eagerly awaiting some of these results. In the past year, there have been approvals for novel drugs in the T-cell lymphoma world.
Why has immunotherapy shown more success in Hodgkin lymphoma as opposed to other hematologic malignancies?
If we understood the biology not only of Hodgkin lymphoma, but other tumors better, I would have a better answer for you. I will say there is something to be said for exceptions to the rule. Hodgkin lymphoma certainly seems to be an exception in its response rate. There is much we can learn about immune evasion and malignancy through Hodgkin lymphoma. This disease is unique in the particular microenvironment it espouses, and its ability for a malignant cell to coordinate its microenvironment and evolve over time.
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