Hope for avoiding chemo in patients with Hodgkins lymphoma

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Published: 8 Dec 2014
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Prof Massimo Federico - University of Modena and Reggio Emilia, Modena, Italy

Data presented at ASH 2014 indicates that brentuximab vedotin was "impressive" as single therapy for patients with Hodgkins lymphoma, bringing complete responses in 11 out of 12 patients investigated for their response to the drug as monotherapy before going onto receive ABVD.

Prof Massimo Federico told ecancertv that the initial success suggests that longer brentuximab courses could be used in place of chemotherapy or radiotherapy in some patients.

Brentuximab vedotin is still licensed as a salvage therapy for patients relapsing after high dose therapy but we had the opportunity to realise a small pilot study using brentuximab vedotin in first line as a single agent for two courses and then we started with conventional chemotherapy, ABVD. What we found was impressive: eleven patients out of twelve, that means all but one, achieved a complete metabolic response with two courses of brentuximab and started treatment for Hodgkin’s lymphoma without any sign of disease at time of ABVD.

So was that monotherapy with brentuximab?

For two courses but for being just a proof of concept study we continued. Although we achieved a complete remission we continued with the standard therapy, that means three or four courses of ABVD. At the end we have 100% of complete response rate.

It sounds very interesting, where do we go from here, do you think?

Now probably we have enough reasons to propose four or six courses of brentuximab vedotin alone and nothing else, at least in the sub-group of patients with favourable Hodgkin’s lymphoma – young females, patients with limited mediastinal mass. So then we could avoid chemotherapy and radiotherapy to these patients, avoiding also the risk of late side effects.

Are there any toxicities with using brentuximab?

For using brentuximab for four courses or six courses is associated with very limited and manageable toxicities. So the only emerging toxicity is neurotoxicity but this happens with eight or more courses of therapy, so after the beginning few courses we didn’t observe any kind of neurological toxicity. We have to take care because sometimes people treated with brentuximab experience some increase of liver enzyme and pancreatic enzyme so we have to take care of these patients to be sure that there is not pancreatic suffering from this treatment.

So what should doctors be taking home from these facts so far from this early study?

Probably in the near future brentuximab could be also licensed as first line therapy, avoiding any kind of chemo-radiotherapy, at least in a limited number of well-selected patients.

Do you think it’s going to rest there or will you go on to further therapy following brentuximab? Is that likely?

Now to be sure we have… I prefer to start, if it’s possible, to start with the brentuximab and then use chemotherapy if necessary but it is too early to arrive at this conclusion. We have to test for more and more years before arriving at this definition on the best use of molecules like brentuximab vedotin.