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Pivotal Data Refine Treatment Strategies in Hodgkin Lymphoma and Follicular Lymphoma

Gina Columbus @ginacolumbusonc
Published: Wednesday, Feb 27, 2019

ALeo I. Gordon MD
Leo I. Gordon MD
Clinical updates in Hodgkin lymphoma and non-Hodgkin lymphoma (NHL) have continued to evolve the space, such as moving away from toxic regimens and more toward a personalized or chemotherapy-free approach, explained Leo I. Gordon, MD.

State of the Science Summit™ on Hematologic Malignancies, Gordon discussed these recent updates in Hodgkin lymphoma and NHL and pointed to research on the horizon.

OncLive: What are the key changes in Hodgkin lymphoma and NHL treatment?

Gordon: The [2 main] issues in Hodgkin lymphoma still remain: first, what to do with PET scans and how to improve results based on PET scans, [and second, answering] the question, “Where are we going in the future?”

A burning question in low-grade lymphoma, especially follicular lymphoma, is what to do with patients who relapse within 24 months of initial therapy. That appears to be a fairly high-risk group, with [data suggesting] that those patients don’t do very well. The questions are, “What do we do upfront?” and “What do we do at the time of first relapse?”

Going back to Hodgkin lymphoma, could you discuss the impact of the FDA approval of the A+AVD regimen?

First of all, that has become the new control arm of an upcoming study that will compare brentuximab vedotin plus AVD with nivolumab (Opdivo), so we are introducing the checkpoint inhibitors in upfront treatment of [patients with] Hodgkin lymphoma. At our institution, we have not identified [A+AVD] as the [standard] frontline therapy yet. However, for the group of patients we think are at risk for pulmonary toxicity from bleomycin, it is a reasonable regimen. Whether [this regimen] should replace ABVD as the standard, I’m not certain yet. The North American subgroup analysis suggests that, once again, brentuximab vedotin offers better progression-free survival (PFS) compared with bleomycin.

We are trading some toxicity, so patients getting brentuximab vedotin have more neutropenia and febrile neutropenia, and they require the use of a growth factor, which isn’t needed with ABVD. I’m concerned whether that will have long-term effects. I also have concerns about the every-2-week use of pegfilgrastim (Neulasta) for 6 cycles or 12 doses in young patients, so unless someone has a significant risk for pulmonary toxicity, we are still using ABVD as our standard.

Have new data with checkpoint inhibitors come out in this space?

We are excited about the use of the checkpoint inhibitors. We did a study years ago on adjuvant [immunotherapy] in [patients with] diffuse large B-cell lymphoma (DLBCL) following autologous stem cell transplant with a checkpoint inhibitor; that was pidilizumab, which is no longer being used. Therefore, we have reasons to think, especially in Hodgkin lymphoma, that [these drugs] are going to be active.


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