Older Patients with Hodgkin Lymphoma Benefit from Treatment with Brentuximab Vedotin

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Brentuximab vedotin is proven an effective and safe first course of treatment for older patients with Hodgkin lymphoma who are not candidates for chemotherapy. These findings were reported in Blood (2015; doi:10.1182/blood-2015-06-644336).

Although standard chemotherapy can achieve complete remission in younger patients with Hodgkin lymphoma, the majority of patients 60 years and older are either ineligible or refuse treatment to avoid complications related to drug toxicity. As the rate of remission is much lower for older patients compared with younger patients with the disease, there is a clear need for less toxic treatments that allow patients 60 years and older to complete their full regimen without complications or interruptions.

Researchers suggest that one promising treatment is brentuximab vedotin, a therapy that targets Hodgkin lymphoma cells and delivers a potent dose of chemotherapy without harming healthy cells. In previous studies, the drug achieved remission in patients with relapsed or treatment-resistant disease.

To examine the potential of brentuximab vedotin as a first course of treatment for older patients with Hodgkin lymphoma, a research team lead by Andres Forero-Torres, MD, of the University of Alabama at Birmingham (UAB) and the UAB Comprehensive Cancer Center, conducted a phase II open-label study evaluating 26 patients (ages 64 to 92 years) who were either ineligible for conventional chemotherapy or declined treatment after receiving information about its risks.

Researchers administered 1.8 mg/kg of IV brentuximab vedotin treatment every 3 weeks for up to 16 doses. Those who benefitted from the drug could continue the treatment after the trial 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% of patients achieved a complete or partial response to the drug that lasted approximately 9.1 months. Of those, 73% achieved a complete remission that lasted approximately 9.2 months. The treatment was generally well-tolerated and consistent with previous reports of brentuximab vedotin in patients with relapsed and treatment-resistant Hodgkin lymphoma. 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 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."

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