EVEROLIMUS WITH DHAP (DEXAMETHASONE, HIGH-DOSE ARAC, CISPLATINUM) IN PATIENTS WITH RELAPSED OR REFRACTORY CLASSICAL HODGKIN LYMPHOMA: A RANDOMIZED, PLACEBO-CONTROLLED PHASE I/II TRIAL (HD-R3I)
Author(s): ,
Bastian von Tresckow
Affiliations:
German Hodgkin Study Group (GHSG), Internal Medicine I,University Hospital of Cologne,Cologne,Germany
,
Andreas Hüttmann
Affiliations:
Universitaetsklinikum Essen,Essen,Germany
,
Vladan Vucinic
Affiliations:
Department of Hematology and Oncology,University of Leipzig,Leipzig,Germany
,
Horst Mueller
Affiliations:
German Hodgkin Study Group (GHSG), Internal Medicine I,University Hospital of Cologne,Cologne,Germany
,
Annette Pluetschow
Affiliations:
German Hodgkin Study Group (GHSG), Internal Medicine I,University Hospital of Cologne,Cologne,Germany
,
Andreas Viardot
Affiliations:
Department of Internal Medicine III,University Hospital Ulm,Ulm,Germany
,
Max Topp
Affiliations:
Medizinische Klinik und Poliklinik II,Universitätsklinikum Würzburg,Würzburg,Germany
,
Paul Bröckelmann
Affiliations:
German Hodgkin Study Group (GHSG), Internal Medicine I,University Hospital of Cologne,Cologne,Germany
,
Carsten Kobe
Affiliations:
Department of Nuclear Medicine,University Hospital of Cologne,Cologne,Germany
,
Boris Böll
Affiliations:
German Hodgkin Study Group (GHSG), Internal Medicine I,University Hospital of Cologne,Cologne,Germany
,
Dennis Eichenauer
Affiliations:
German Hodgkin Study Group (GHSG), Internal Medicine I,University Hospital of Cologne,Cologne,Germany
,
Stephanie Sasse
Affiliations:
German Hodgkin Study Group (GHSG), Internal Medicine I,University Hospital of Cologne,Cologne,Germany
,
Heinz Haverkamp
Affiliations:
Institute of Medical Statistics and Computational Biology,Faculty of Medicine, University of Cologne,Cologne,Germany
,
Michael Fuchs
Affiliations:
German Hodgkin Study Group (GHSG), Internal Medicine I,University Hospital of Cologne,Cologne,Germany
,
Andreas Engert
Affiliations:
German Hodgkin Study Group (GHSG), Internal Medicine I,University Hospital of Cologne,Cologne,Germany
Peter Borchmann
Affiliations:
German Hodgkin Study Group (GHSG), Internal Medicine I,University Hospital of Cologne,Cologne,Germany
EHA Library. von Tresckow B. Jun 15, 2019; 266857; PS1240
Dr. Bastian von Tresckow
Dr. Bastian von Tresckow
Contributions
Abstract

Abstract: PS1240

Type: Poster Presentation

Presentation during EHA24: On Saturday, June 15, 2019 from 17:30 - 19:00

Location: Poster area

Background
Induction chemotherapy followed by BEAM high dose chemotherapy (HDCT) and autologous peripheral blood stem cell transplant (PBSC transplant) is standard of care for transplant-eligible patients with relapsed or refractory classical Hodgkin lymphoma (rrHL). However, approx. 50% of patients relapse and therefore, this strategy must be improved.

Aims
As response to induction therapy is predictive of the outcome after HDCT, this trial aimed at improving the response to induction therapy by adding oral everolimus to time-intensified standard DHAP (Ever-DHAP).

Methods
We included patients with histologically confirmed rrHL aged 18-60 years in this phase I/II trial. Dosage of everolimus was pre-determined in the phase I part with 10 mg/day in parallel to DHAP for 14 days within each of two cycles. The phase II part started as a randomized controlled trial comparing 50 patients in the everolimus group to 50 patients in a placebo group. The primary endpoint of the phase II part was the CT-based complete remission (CR-) rate after two cycles of Ever-DHAP. This CR-rate would be expected to be ≥ 40% if adding everolimus was effective. Secondary endpoints of the trial were PET-based CR-rate after two cycles of induction, progression-free and overall survival as well as time to recovery, adverse events, duration of induction therapy, discontinuation rates and rates of successful PBSC collection. The trial was registered at ClinicalTrials.gov with ID NCT01453504.

Results
From 7/2014 to 3/2018 we recruited a total of 59 patients in the phase II part. Because of poor recruitment the placebo group was closed in 9/2015 after 9 patients were randomized. Of 50 patients in the everolimus group 2 did not start therapy; 3 additional patients discontinued Ever-DHAP because of toxicity. Nine patients (20%) and 13 patients (28%) needed dose reductions in the first and second cycle of Ever-DHAP, respectively. A delayed recovery >14 days was observed in 2 patients (5%) in cycle 1 and in 6 patients (13%) in cycle 2. CTCAE grade IV toxicities occurred in 39 patients (95%) and 27 patients (75%) in cycle 1 and 2, respectively. All grade IV-toxicities were hematological toxicities. Apheresis needed 1 day in 35 (80%) of the Ever-DHAP patients and 2 days in 8 patients (18%). PBSC collection was successful in 38/42 documented patients receiving Ever-DHAP (91%). After two cycles of therapy we observed a CT-based CR in 12/45 patients of the everolimus group (27%) and in 2/9 patients of the placebo group (22%). A PET-based CR was achieved by 22/39 patients of the everolimus group (56%) and by 2/8 patients of the placebo group (25%). In the everolimus group 2 patients had progressive disease (4%) and 3 died (7%, not related to Ever-DHAP). Final results and additional analyses will be presented.

Conclusion
With a CT-based CR-rate of 27% after two cycles of everolimus plus DHAP (PET-based CR-rate 56%), the trial did not meet the primary endpoint. Adding everolimus to time-intensified DHAP is feasible, however, everolimus plus DHAP failed to show an improved efficacy.

Session topic: 17. Hodgkin lymphoma - Clinical

Keyword(s): Autologous peripheral blood stem cell tansplantati, High dose therapy, Hodgkin's lymphoma, Relapsed lymphoma

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