Bretuximab vedotin safe, effective for older Hodgkin lymphoma patients unfit for chemotherapy

A study, published online in Blood, the Journal of the American Society of Hematology (ASH), reports that bretuximab vedotin is an effective and safe first course of treatment for older Hodgkin lymphoma patients unfit for chemotherapy.

While standard chemotherapy can achieve complete remissions in younger Hodgkin lymphoma (HL) patients, the majority of those 60 and older are either ineligible or refuse treatment in order to avoid complications related to drug toxicity. As the rate of remission is much lower for older compared to younger HL patients, there is a clear need for less toxic treatments that allow patients 60 and older to complete their full regimen without complications or interruptions. Researchers suggest that one promising treatment is brentuximab vedotin, a therapy that targets HL cells and delivers a potent dose of chemotherapy without harming healthy cells. In previous studies, BV has achieved remissions in patients with relapsed or treatment-resistant disease.

To examine the potential of BV as a first course of treatment for older HL patients, a research team lead by Andres Forero-Torres, MD, of the University of Alabama at Birmingham and the UAB Comprehensive Cancer Center, conducted a Phase 2 open-label study evaluating 26 patients (ages 64 to 92) who were either ineligible for conventional chemotherapy or declined treatment after receiving information about its risks. Researchers administered 1.8 mg/kg of intravenous BV treatment every three weeks for up to 16 doses. Those who benefitted from the drug could continue beyond this time period until disease progression, unacceptable toxicity, or study closure. Patients received a median of eight cycles, with four completing 16 and one completing 23 cycles.

At the time of analysis, 92 percent of patients achieved a complete or partial response to the drug that lasted approximately 9.1 months. Of those, 73 percent achieved a complete remission that lasted approximately 9.2 months. The treatment was generally well-tolerated and consistent with previous reports of BV in patients with relapsed and treatment-resistant HL. The most common adverse event was peripheral sensory neuropathy (78%). Fewer than half of patients experienced fatigue and nausea.

"In this population of older patients with Hodgkin lymphoma who were unfit for standard chemotherapy, we observed that brentuximab vedotin as a single agent produced a very high rate of response, including a very high rate of complete remission," said Dr. Forero-Torres. "While we observed promising responses, the next step is to evaluate this drug in combination with additional chemotherapy or immunotherapies that might allow us to prolong the response without relapse."