Published on February 12, 2020
- Hodgkin lymphoma is often a very treatable and curable disease for many patients. The goal has always been to reduce toxicity and exposure to chemo while monitoring side effects to maximize the quality of life.
- For advanced Hodgkin lymphoma, there are new FDA approvals allowing drugs to move up to front-line treatment.
Hodgkin lymphoma expert Dr. Sairah Ahmed, from The University of Texas MD Anderson Cancer Center, joins Patient Power Co-Founder Esther Schorr to talk about newly diagnosed patients and the opportunities they have for treatment options and clinical trials. Watch as Dr. Ahmed discusses a number of studies for Hodgkin lymphoma designed to improve outcomes and to reduce toxicities
Transcript | Treatment for Newly Diagnosed Hodgkin Lymphoma
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We’re very careful when we talk about newly diagnosed Hodgkin lymphoma, because it is often a very treatable and curable disease for a large number of patients. We want to make sure that we keep those stellar outcomes without compromising people’s long-term remission rates, but at the same time decrease the toxicity associated with the chemotherapy that they get. In advanced Hodgkin lymphoma, there is now an FDA approval for using brentuximab vedotin (Adcetris), which is an anti-CD30 antibody, in combination with chemotherapy for Hodgkin lymphoma.
That drug in particular, as well as other drugs called PD-1 inhibitors, or checkpoint inhibitors, are moving closer to frontline. So, SWOG actually is opening a multi-institutional trial, looking at AVD, which is the standard chemotherapy given for Hodgkin lymphoma, with either brentuximab vedotin, or nivolumab (Opdivo), which is a PD-1 inhibitor. So, people will actually be randomized to one arm or the other and get those drugs. The hope is that they have the same great outcomes with less toxicity.
So, it sounds like along the whole spectrum there are starting to be more and more possibilities for treating this disease. Is that accurate?
Yes, absolutely. So, the whole goal for Hodgkin lymphoma has always been to decrease toxicity, to decrease exposure to chemotherapy, to get the same great outcomes. One population of patients that generally are underserved, I believe, are older patients. So, the clinical trials tend to have upper age limits, and yet the incidents of Hodgkin lymphoma is increased in older adults. There’s a bi-modal pattern. You have folks that are diagnosed early, ages 18 to 25, and then you have another peak above the age of 50, and yet, clinical trials will tend to cap the upper age limit.
So, only about 5 percent of patients in clinical trials are older adults, and yet they probably represent somewhere about 25 percent to 35 percent of the overall population. So, there are a number of studies that have looked at ways to improve outcomes for older adults and minimize toxicity. One of the ways is to actually fractionate the drug, so that same drug, brentuximab vedotin, Dr. Andy Evans of Rutgers actually had a clinical trial where he used the brentuximab in between conventional chemotherapy, so that folks did not have as much toxicity as when they use both, or all of those drugs together.
So, it evens out the effects.
Right and had really great responses. So, I think that’s some of the stuff that we need to start to look at, is how do we get patients through the chemotherapy with good quality of life and monitor and maintain the toxicity, so that we don’t have long-term side effects from a really treatable and curable disease.
Dr. Ahmed, thank you so much for giving us these insights. I know that our audience will really appreciate hearing this update for them. This is Esther Schorr from ASH, and remember, knowledge can be the best medicine of all.