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For patients with relapsed / refractory classical Hodgkin lymphoma ( cHL ), second-line therapy with a combination of intensive dose-dense brentuximab vedotin ( BV ) and ifosfamide , carboplatin , and etoposide ( ICE ) chemotherapy led to high rates of complete response ( CR ), according to findings published in Lancet Haematology .

ICE is the most commonly used chemotherapybased salvage regimen in the U . S ., corresponding study author Ajay Gopal , MD , of the University of Washington in Seattle , told ASH Clinical News . Dr . Gopal added that this study represents the first publication of results of BV-ICE and is “ the first to show that higher-than-standard per-cycle dosing can be safely combined with short course chemotherapy .”

Dr . Gopal added that the BV-ICE regimen “ may be preferred for younger , high-risk patients with cHL when rapid achievement of remission is required .” The researchers wrote that the combination may be particularly feasible in transplantation-eligible patients younger than age 60 with cHL in first relapse .

In this open-label , phase I / II study , Dr . Gopal and researchers examined the safety and activity of dose-dense BV-ICE as a second-line treatment in 45 patients with cHL . In the phase I portion , investigators conducted a 3 + 3 dose escalation study to identify a maximum tolerated dose of the regimen to be used in phase II .

Per study protocol , BV was intravenously administered on days one and eight at 1.2 mg / kg ( dose level 1 ) or 1.5 mg / kg ( dose level 2 ). Standard ICE doses were administered on days one through three for two cycles , with each cycle lasting 21 days .

The median age of patients in the study was 31 years . Approximately 96 % of patients ( n = 43 ) received ABVD ( doxorubicin , bleomycin , vinblastine , and dacarbazine ) as primary therapy , with or without omission of bleomycin . Nearly two-thirds of patients ( 64 %; n = 29 ) had primary refractory cHL at baseline , and 84 % ( n = 38 ) were considered at high risk of relapse . Most patients in the study cohort were women ( 64 %).

The first three patients in the phase I portion of the trial received BV 1.2 mg / kg and showed no signs

TABLE . Response Rates at the End of Therapy

Complete Response

Partial Response

of dose-limiting toxicities . In contrast , the next six patients treated with BV 1.5 mg / kg experienced dose-limiting toxicities . Given these findings , 1.5 mg / kg was established as the maximum tolerated dose and the recommended phase II dose .

After a median follow-up of 3.1 years , most evaluable patients ( 74 %) achieved CR after two treatment cycles ( TABLE ). The researchers noted that this CR rate fell under the prespecified CR target of 78 %. In a post hoc subgroup analysis of 28 patients with primary refractory disease , the overall response rate was 86 %, while the CR rate was 68 %.

The researchers noted relatively high rates of grade 3 / 4 hematologic adverse events ( AEs ), including :

• neutropenia ( 73 %)

• anemia ( 13 %)

• thrombocytopenia ( 80 %)

The most common grade 3 / 4 , non-hematologic AEs included : febrile neutropenia ( 9 %), sepsis ( 13 %), increased alanine aminotransferase ( 11 %), hyperglycemia ( 7 %), pulmonary embolism ( 4 %), and increased aspartate aminotransferase ( 4 %).

Thirteen patients ( 29 %) experienced serious AEs . One on-treatment death occurred , which the authors reported was caused by multisystem organ failure and deemed related to the therapy .

“ Our data suggest that dose-dense BV-ICE is a rapidly administered and active salvage regimen for patients with relapsed or refractory cHL , despite a complete response in this trial lower than the prespecified phase II target ,” the authors concluded . “ Although cross-trial comparisons should be made with caution , activity results seem to be similar to previously presented BV chemotherapy salvage combinations delivered over much longer durations and can be considered in young (< 60 years ), transplantation-eligible patients for second-line therapy .”

Describing potential limitations of this study , Dr . Gopal acknowledged its single-arm , phase I / II design .

Stable Disease

Progressive Disease

Overall Response Rate

“ Intensive BV dosing with multi-agent platinum-based chemotherapy needs to be compared against BV anti-PD1 combinations in the second line ,” he said .

Study authors reported relationships with Seagen , which sponsored and funded the trial .

Reference Lynch RC , Cassaday RD , Smith SD , et al . Dose-dense brentuximab vedotin plus ifosfamide , carboplatin , and etoposide for second-line treatment of relapsed or refractory classical Hodgkin lymphoma : a single centre , phase 1 / 2 study . Lancet Haematol . 2021 ; 8 ( 8 ): e562-e571 .

Patients with lymphoma tend to report and show signs of worsening cognitive function at six months after chemotherapy compared with healthy controls , according to study findings recently published in the Journal of the National Care Institute .

Corresponding study author Michelle C . Janelsins , PhD , of the James P . Wilmot Cancer Institute in Rochester , New York , told ASH Clinical News that cognitive problems appear to be “ something for clinicians treating patients with lymphoma to be aware of and monitor during treatment ,” given the potential impact of cancer-related cognitive decline on quality of life and treatment outcomes .

Dr . Janelsins and colleagues assessed longitudinal changes in memory , attention , and executive function in men and women with lymphoma ( n = 248 ; 62.5 % male ) prior to and six months after initiation of chemotherapy . Standardized cognitive assessments and self-reported measures were used to evaluate cognition during the study .

A group of age- and sex-matched people without cancer was used as a control arm ( n = 212 ; 59 % male ). In addition to the comparison of cognitive changes

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