Brentuximab Vedotin Effective in Elderly Hodgkin Lymphoma Patients

Andres Forero-Torres, MD

Andres Forero-Torres, MD

New evidence suggests that there may be a safe and effective treatment option for older patients with Hodgkin lymphoma who are ineligible for chemotherapy.

In a phase II, open-label study, researchers administered the antibody-drug conjugate brentuximab vedotin (Adcetris) as frontline therapy to patients aged 60 and older who were either unfit to receive chemotherapy or declined treatment because of the risks.

The study, published online in Blood, showed that the overall response rate (ORR) was 92%, and 73% of those achieved complete remission.

All of the patients achieved stable disease or better and had decreased tumor volume following treatment of brentuximab vedotin.

“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,” lead author Andres Forero-Torres, MD, of the University of Alabama at Birmingham and the UAB Comprehensive Cancer Center, said in a statement.

Brentuximab vedotin targets Hodgkin lymphoma cells and delivers a potent dose of chemotherapy without harming surrounding healthy cells, and previous studies have shown that the therapy has achieved remissions in patients with relapsed or treatment-resistant disease.

For the study, researchers administered 1.8 mg/kg of brentuximab vedotin intravenously to 26 patients every 3 weeks for up to 16 doses. Patients who benefitted from the treatment could continue past 16 doses until cancer progression, intolerable toxicity, or study closure. The patients received a median of 8 cycles, with 4 completing 16 cycles, and 1 patient completing 23 doses.

The median duration of objective response was 9.1 months (range, 2.8 to 20.9+) and median progression-free survival was 10.5 months (range, 2.6+ to 22.3+).

The treatment was well tolerated, with the most common adverse event being peripheral sensory neuropathy (78%). Fatigue and nausea were experienced by 44% of patients.

Peripheral neuropathy occurred in 30% of patients, most of whom had risk factors of diabetes or hypothyroidism.

The adverse events were consistent with previous studies of brentuximab vedotin.

Standard chemotherapy can be effective in achieving complete remission in younger patients with Hodgkin lymphoma; however, outcomes in older patients tend to be poor following chemotherapy due to treatment-related toxicity and comorbidities.

The authors concluded that this study shows brentuximab vedotin monotherapy has the potential to provide a safe and effective frontline treatment option for elderly patients unable or unwilling to receive conventional chemotherapy.

Still, further studies of the drug are to come.

“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,” Forero-Torres said.

Forero-Torres A, Holkova B, Goldschmidt J, et al. Phase 2 study of frontline brentuximab vedotin monotherapy in Hodgkin lymphoma patients aged 60 years and older [published online before print September 16, 2015]. Blood.