Cancer Conference Update: A Multimedia Review of Key Presentations from the 2016 American Society of Hematology Annual MeetingAbstract 1105: Brentuximab vedotin in combination with nivolumab for patients with relapsed or refractory Hodgkin lymphoma
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TRANSCRIPTION:
DR FLOWERS: This is a very interesting approach. And I think the combination of B-vedotin with immunotherapy is one that you’ll see a theme across this American Society of Hematology meeting. This is a very nice abstract that was presented by Alex Herrera, where they looked at B-vedotin in combination with nivolumab in patients with relapsed and refractory Hodgkin lymphoma who had failed standard front-line therapies. In this setting, patients received the standard dose of B-vedotin given at 1.8 mg/kg and then received escalating doses of nivolumab, here given at 3 mg/kg on cycle 1, day 8, initially. And then the two were given on the same day with each subsequent cycle. When you look at this trial, the adverse events that were seen were reasonably frequent, although the severity of the adverse events was predominantly Grade 2 or less. There were no Grade 4 adverse events seen in the patients. And fatigue was the most common AE that was seen in the population. I think the response rates seen in here are at least encouraging. But at this point, there were relatively too few patients that have been seen and reviewed to really know kind of how that will play out over a larger number of patients. DR LOVE: Where do you see things heading for this combination? And how concerned are you about the toxicities? I mean, usually PD-1 alone is not much of a problem. DR FLOWERS: Right. So I think the combinations that you’ll hear about, the combination of brentuximab plus nivolumab is an intriguing one. From this we see relatively limited toxicities. There’s a combination of brentuximab and ipilimumab and then the combination of all three, brentuximab, ipilimumab and nivolumab, which are the ways that things are moving forward. I think, much like what has been seen for melanoma, we need to start to think about, kind of, what is the best approach for patients who have aggressive-behaving disease? There, it’s more looked at in the up-front setting. Here, we’re looking at the relapsed setting, but the questions are similar. It’s should we use the best combination of agents to try and get the best response and the deepest response, or should we sequence agents in order to try and limit toxicity and prolong responses, or prolong the duration of progression-free survival? Particularly with nivolumab and the other PD-1 inhibitors, the other thing that we’ve seen is that patients can progress. But as long as they’re progressing slowly and still continuing to maintain their quality of life that that’s another approach that is a viable, very viable approach for patients. So combination therapy versus sequencing therapy is another question that we’re going to have to answer once we answer the safety and the efficacy of these agents. |