Contributions
Abstract: PB2014
Type: Publication Only
Background
The main problems in the modern treatment of classical Hodgkin's lymphoma (cHL) are patients with refractory disease and relapses after ASCT. The most promising for this category of patients seems to be the use of a new class of monoclonal antibodies – PD-1 (nivolumab, pembrolizumab)/ They block the interaction between the receptor of PD-1 on activated T-lymphocytes and its ligands (PD-L1, PD-L2) on tumor cells, simulate the antitumor immune response.
Aims
evaluate the effectiveness and safety of therapy of a new class of monoclonal antibodies – PD-1 (nivolumab).
Methods
According to the NPP program" in N.N. Blokhin National Cancer Research Center 12.2015 to 09.2017 treatment with Nivolumab was given to 18 patients with relapses
efractory cHL. The median ages are 35 years. The median line of the therapy before the nivolumab was 4 (2-8): 13 (72%) patients underwent ASCT, 4 were not candidates for autograft, 3 received treatment brentuximab vedotin (1 with autograft, 2 - only BV). ECOG was predominantly 2, in 3 patients - 3. Nivolumab was administered at a dose of 3 mg/kg every 2 weeks before the progression or realization of adverse events (AEs). The median number of treatment courses is 25 (1-44). The effect of therapy was assessed in 17 patients, 1 patient was excluded from the evaluation due to the development of serious AE after the first administration.
Results
Treatment was effective in 53% of patients (9 patients), of whom full remissions (PR) were achieved in 29% (5 patients). Stabilization with a median duration of the effect of 15 months was found in 7, and in 1 patient - progression after 9 injections of nivolumab. By 09.2017 16 out of 17 patients are alive, in whom the effect is estimated, 9 of them remain without progression, including all 5 patients with PR. From the progression of LH died 1 patient. With median follow-up of 18 months (from 1 to 27 months), the median survival to progression was 16 months, overall survival was 94%. It should be noted that all but the patient with progression and the patient withdrawn from treatment in connection with the development of AE, noted a significant clinical improvement and an increase in general status to ECOG 0-1. Of the complications of treatment, Herpes zoster (1), community-acquired pneumonia (3), transient elevation of transaminase levels> 4 norms (1) were noted. One patient had a serious immune-mediated reaction (demyelination) after the first administration of nivolumab, which caused the drug to be discontinued.
Conclusion
Immunotherapy with PD-1 inhibitors (nivolumab) is highly effective in relapses and refractory cHL, it has moderate toxicity, however, the possibility of developing immune-mediated reactions requires further accumulation of material and additional attention of the physician.
Session topic: 17. Hodgkin lymphoma – Clinical
Keyword(s): Hodgkin's Lymphoma, Relapse
Abstract: PB2014
Type: Publication Only
Background
The main problems in the modern treatment of classical Hodgkin's lymphoma (cHL) are patients with refractory disease and relapses after ASCT. The most promising for this category of patients seems to be the use of a new class of monoclonal antibodies – PD-1 (nivolumab, pembrolizumab)/ They block the interaction between the receptor of PD-1 on activated T-lymphocytes and its ligands (PD-L1, PD-L2) on tumor cells, simulate the antitumor immune response.
Aims
evaluate the effectiveness and safety of therapy of a new class of monoclonal antibodies – PD-1 (nivolumab).
Methods
According to the NPP program" in N.N. Blokhin National Cancer Research Center 12.2015 to 09.2017 treatment with Nivolumab was given to 18 patients with relapses
efractory cHL. The median ages are 35 years. The median line of the therapy before the nivolumab was 4 (2-8): 13 (72%) patients underwent ASCT, 4 were not candidates for autograft, 3 received treatment brentuximab vedotin (1 with autograft, 2 - only BV). ECOG was predominantly 2, in 3 patients - 3. Nivolumab was administered at a dose of 3 mg/kg every 2 weeks before the progression or realization of adverse events (AEs). The median number of treatment courses is 25 (1-44). The effect of therapy was assessed in 17 patients, 1 patient was excluded from the evaluation due to the development of serious AE after the first administration.
Results
Treatment was effective in 53% of patients (9 patients), of whom full remissions (PR) were achieved in 29% (5 patients). Stabilization with a median duration of the effect of 15 months was found in 7, and in 1 patient - progression after 9 injections of nivolumab. By 09.2017 16 out of 17 patients are alive, in whom the effect is estimated, 9 of them remain without progression, including all 5 patients with PR. From the progression of LH died 1 patient. With median follow-up of 18 months (from 1 to 27 months), the median survival to progression was 16 months, overall survival was 94%. It should be noted that all but the patient with progression and the patient withdrawn from treatment in connection with the development of AE, noted a significant clinical improvement and an increase in general status to ECOG 0-1. Of the complications of treatment, Herpes zoster (1), community-acquired pneumonia (3), transient elevation of transaminase levels> 4 norms (1) were noted. One patient had a serious immune-mediated reaction (demyelination) after the first administration of nivolumab, which caused the drug to be discontinued.
Conclusion
Immunotherapy with PD-1 inhibitors (nivolumab) is highly effective in relapses and refractory cHL, it has moderate toxicity, however, the possibility of developing immune-mediated reactions requires further accumulation of material and additional attention of the physician.
Session topic: 17. Hodgkin lymphoma – Clinical
Keyword(s): Hodgkin's Lymphoma, Relapse