Studies presented at the ASCO Annual Meeting 2023 highlighted new developments in lymphoma that could lead to changes in practice.
Results from the phase 3 SWOG-S1826 trial indicated that combination treatment with nivolumab, doxorubicin, vinblastine, and dacarbazine could be a new standard of care for patients with advanced Hodgkin lymphoma.1
Results from the prospective IELSG37 trial suggested that radiation may be unnecessary in patients with primary mediastinal B-cell lymphoma (PMBCL) who have a complete metabolic response after frontline chemotherapy.2
Findings from the phase 2 JACKPOT8 study pointed to golidocitinib as a potential novel treatment option for patients with relapsed or refractory peripheral T-cell lymphoma (PTCL).3
And another phase 2 trial showed that first-line treatment with mogamulizumab and chemotherapy can improve progression-free survival (PFS), compared to a historical control, in elderly patients with adult T-cell leukemia/lymphoma (ATL).4
SWOG-S1826: Nivolumab Plus AVD May Be New Standard of Care
Nivolumab plus doxorubicin, vinblastine, and dacarbazine (AVD) improved PFS when compared to brentuximab vedotin plus AVD in patients with advanced Hodgkin lymphoma in the S1826 trial.1
The trial (ClinicalTrials.gov Identifier: NCT03907488) enrolled patients aged 12 years and older who had newly-diagnosed, stage III-IV classic Hodgkin lymphoma. The patients were randomly assigned to receive nivolumab plus AVD or brentuximab vedotin plus AVD for 6 cycles. G-CSF was given to 95% of patients in the brentuximab vedotin arm and 54% of those in the nivolumab arm. Radiotherapy was given to 0.8% and 0.4%, respectively.
The efficacy analysis included 489 patients in the nivolumab arm and 487 in the brentuximab vedotin arm. Baseline characteristics were generally similar between the arms.
At a median follow-up of 12.1 months, PFS was significantly better in the nivolumab arm than in the brentuximab vedotin arm (hazard ratio [HR], 0.48; 99% CI, 0.27-0.87; P =.0005). The 1-year PFS rate was 94% in the nivolumab arm and 86% in the brentuximab vedotin arm.
Event-free survival (EFS) was significantly better in the nivolumab arm as well (HR, 0.56; 99% CI, 0.33-0.95; P =.0019). The 1-year EFS rate was 91% in the nivolumab arm and 84% in the brentuximab vedotin arm.
Overall survival (OS) data were not mature, but the 1-year OS rate was 99% in the nivolumab arm and 98% in the brentuximab vedotin arm. There were 11 deaths in the brentuximab vedotin arm and 4 in the nivolumab arm.
The safety analysis included 483 patients in the nivolumab arm and 473 in the brentuximab vedotin arm. Infectious toxicities — rates of febrile neutropenia, sepsis, and infections/infestations — were similar between the arms.
Rates of neutropenia were higher with nivolumab-AVD than with brentuximab vedotin-AVD. The rates of any-grade neutropenia were 55% and 32%, respectively. Rates of grade 3 or higher neutropenia were 47% and 25%, respectively.
Rates of peripheral neuropathy were higher with brentuximab vedotin-AVD than with nivolumab-AVD. The rates of peripheral sensory neuropathy were 55% and 29%, respectively. Rates of peripheral motor neuropathy were 7% and 4%, respectively.
Additional results from the S1826 trial are expected to confirm long-term safety and the durability of PFS as well as reveal findings on secondary endpoints such as OS and patient-reported outcomes.
“Based on the improved efficacy of nivolumab-AVD over brentuximab vedotin-AVD and the more favorable toxicity profile, we expect that nivolumab plus AVD will become a standard of care for advanced stage Hodgkin lymphoma,” study presenter Alex Herrera, MD, of City of Hope in Duarte, California, said in an interview.
“This is a very important result that will impact the treatment of classical Hodgkin lymphoma in the very immediate future,” said Richard F. Ambinder, MD, PhD, of the Johns Hopkins Kimmel Cancer Center in Baltimore, who was not involved in this study. “It follows other big successes in treating Hodgkin lymphoma in recent years and will be another significant change that will make chemotherapy more tolerable and more effective.”
IELSG37: Radiotherapy May Be Unnecessary for Certain PMBCL Patients
In the IELSG37 trial — the largest prospective study of PMBCL patients to date — results suggested that radiotherapy can be safely omitted in patients who have a complete metabolic response after immunochemotherapy.2
Investigators conducted this trial to “put an end to a long-lasting controversy” about the need for radiotherapy in this setting, explained study presenter Emanuele Zucca, MD, of the Oncology Institute of Southern Switzerland in Bellinzona.
The trial (ClinicalTrials.gov Identifier: NCT01599559) included 530 patients who received rituximab and anthracycline-based chemotherapy, followed by central PET review. Of those patients, 268 achieved a complete metabolic response and were randomly assigned to observation (n=132) or consolidation radiotherapy (n=136). Baseline characteristics were similar between the arms.
The PFS rate at 30 months post-randomization was 96.2% in the observation arm and 98.5% in the radiotherapy arm (P =.274). This difference is not statistically significant and probably not clinically relevant, according to Dr Zucca.
The unadjusted HR for the relative effect of radiotherapy compared to observation was 0.47 (95% CI, 0.12-1.88). After adjustment, the HR was 0.68 (95% CI, 0.16-2.91).
The 30-month OS rate was 99.2% in the observation arm and 99.3% in the radiotherapy arm (P =.601).
There were few late adverse events (AEs), but all were seen in the radiotherapy arm. There were 3 cases of severe cardiac AEs and 3 second malignancies.
“So the take-away message is that the study is the largest trial ever conducted in this disease, and mediastinal radiotherapy may be safely omitted in patients with complete metabolic response after frontline immunochemotherapy,” Dr Zucca said.
“The IELSG37 trial reported excellent outcomes for patients with PMBCL who achieve a complete metabolic response at the end of induction therapy, and the findings suggested that the addition of radiation therapy for these patients is not necessary,” said Reid Merryman, MD, of the Dana-Farber Cancer Institute in Boston. “We look forward to an update on patients who had a positive PET scan at the end of induction in this trial, who were not included in this abstract.”
This article originally appeared on Cancer Therapy Advisor