Publication date: Feb 13, 2020
Advances and Setbacks With Precision Medicine in Hodgkin Lymphoma, T-Cell Lymphomas Brentuximab vedotin (Adcetris), an anti-CD30 antibody-drug conjugate, was approved by the FDA as treatment of patients with relapsed/refractory Hodgkin lymphoma (HL), based on data from the multicenter, randomized phase III ECHELON-1 clinical trial.
The other approach to treating HL is with doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine (ABVD) therapy, based on findings from the phase III RATHL trial. Patients who were randomized to receive brentuximab vedotin plus doxorubicin, vinblastine, and dacarbazine (A+AVD) had an improved progression-free survival (PFS) compared to those who received the standard ABVD therapy in the ECHELON-1 study.
ABVD therapy is the current standard of care in this setting, while A+AVD has not been universally adopted yet. With these 2 treatments, HL is considered a highly curable disease, according to Allison J. Moskowitz, MD.
Among these therapies, checkpoint inhibitors nivolumab (Opdivo) and pembrolizumab (Keytruda) are also approved for the treatment of patients with HL who have already received at least 3 prior lines of therapy.
However, because the first- and second-line therapies have such promising cure rates, most patients with HL will never need treatment with 1 of these immunotherapeutic agents. In an interview with Targeted Oncology, Moskowitz, assistant attending, Lymphoma Service, Memorial Sloan Kettering Cancer Center, discussed the treatment options for patients with HL and what research is still to come in the field.
The role precision medicine can take in HL is to choose the right treatment for the right patient at the right time so that we are not overtreating patients or undertreating patients. In T-cell lymphoma, we still have a lot of work to do because the prognosis in general for many of the entities is still unfavorable.
We also need new treatment approaches for some of the rarer entities in T-cell lymphoma so that we can make a difference in that disease. In the frontline setting for early-stage patients, certain risk factors are used to decide whether a patient has favorable disease or unfavorable disease .
Ongoing prospective studies are now incorporating this measurement in there so we can learn more about how we can use it to predict how a patient is going to do and how to choose therapy. Another really exciting marker that I think is going to make a difference in HL is ctDNA, which enables us to not only look at the mutations within the patient’s tumor by looking at their blood, but this also may be a good marker for assessing responses to therapies.
It makes it very difficult to run clinical trials because it requires very broad collaboration internationally in order to allow enough patients on the study to get an idea of whether these drugs and treatment approaches are working.
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