The widely used immunotherapy drug nivolumab (Opdivo) is safer and more effective in treating adults and children with advanced Hodgkin lymphoma than the targeted therapy now used as standard of care, new clinical trial results show.
Nivolumab outperformed the drug brentuximab vedotin (Adcetris), extending progression-free survival by 94% to one year versus 86%.
Nivolumab also produced significantly fewer side effects than brentuximab vedotin, which was the first new therapy developed for Hodgkin lymphoma, Herrera said in a presentation Sunday at the American Society for Clinical Oncology (ASCO) annual meeting. ) in Chicago.
“Based on these data, nivolumab is poised to become a new standard of care for advanced-stage Hodgkin lymphoma,” Herrera said.
Hodgkin lymphoma is a type of cancer that starts in white blood cells called lymphocytes, according to the American Cancer Society.
According to ASCO, 8,830 new cases of Hodgkin’s lymphoma are expected to be diagnosed in the United States in 2023, and 900 patients will die from the cancer. The five-year survival rate for advanced disease is 83%.
“It disproportionately affects young patients, people in their teens, 20s, 30s,” Herrera said. “There is a long history of treating this cancer and over the years we have used increasing doses of radiation and increasing doses of chemotherapy to try to maximize cure.”
Approved in 2018 as a first-line treatment for adults with advanced Hodgkin lymphoma, brentuximab vedotin is an antibody-based drug that attaches to cancer cells and releases a drug that causes cell death.
Adding brentuximab vedotin to chemotherapy improved outcomes and survival, but the drug also increased side effects in both adult and pediatric patients, Herrera said.
Additionally, as many as 60 percent of pediatric patients with Hodgkin’s lymphoma also required radiation therapy with this regimen, increasing the risk of long-term health problems.
The advent of nivolumab offered a potential alternative to brentuximab vedotin, Herrera said.
Some cancer cells carry a protein called PD-L1 that essentially masks them from being detected by T cells. Nivolumab stops PD-L1 from working, allowing immune cells to target and destroy tumours.
“Hodgkin’s lymphoma is the poster child for the use of PD-1 blockade,” Herrera said. “There are genetic changes in the Hodgkin’s lymphoma cancer cell that lead to the expression of PD-1 ligands on the surface of Hodgkin’s lymphoma cells.”
Nivolumab is already approved for the treatment of a broad range of cancers, including non-small cell lung cancer, melanoma, kidney cancer, head and neck cancer, liver cancer, bladder or urinary tract cancer, colon cancer and esophageal cancer, according to the drug manufacturer. Bristol Myers Squibb.
For this study, funded by the National Institutes of Health, researchers recruited nearly 1,000 Hodgkin lymphoma patients, ages 12 and older, who had not received any treatment.
Half were assigned to receive nivolumab with chemotherapy and the rest received brentuximab vedotin and chemo.
At one year later, nivolumab had a 52% reduction in the risk of disease-related death compared with brentuximab vedotin.
Nivolumab patients also had fewer side effects, including fewer infections, sepsis and neuropathy, Herrera said.
“There was more peripheral neuropathy in the brentuximab vedotin arm, and I can’t stress enough how important neuropathy is as a side effect in these young patients who have the rest of their lives ahead of them,” Herrera said. “It’s great to cure cancer, but it’s hard to live without being able to feel your fingers and toes.”
About 22 percent of brentuximab vedotin-treated patients had to stop treatment due to side effects, compared with 11 percent of nivolumab patients, Herrera said.
These findings could mean a new standard of care for both adults and children, said Dr. Julie Gralow, ASCO’s chief medical officer.
“I can tell you that Hodgkin’s lymphoma doctors are really excited about nivolumab,” Gralow said.
Dr. Oreofe Odejide, a hematologist oncologist at the Dana-Farber Cancer Institute in Boston, agrees.
“This study was an unprecedented effort across all of the North American clinical trial cooperative groups to improve the cure rate in advanced-stage Hodgkin lymphoma and harmonize treatment approaches between pediatric and adult patients,” Odejide said in a news release. . “Collaborations between adult and pediatric groups have helped pave the way for a new standard of care that is better tolerated and results in a higher proportion of patients with durable remissions.”
Findings presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.
The American Cancer Society has more on Hodgkin’s lymphoma.
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