Patients with relapsed/refractory Hodgkin lymphoma had a longer progression-free survival when taking decitabine plus camrelizumab compared with camrelizumab alone, according to research in the Journal of ImmunoTherapy of Cancer.
Anti-programmed death-1 (PD-1) antibodies produce an objective response in patients with classical Hodgkin lymphoma who have failed autologous stem cell transplantation and prior therapies. However, median progression-free survival (PFS) remains at about 11 to 15 months.
The DNA methyltransferase (DNMT) inhibitor decitabine has been used in low doses in some hematologic malignancies. In this 2-arm, open-label, randomized, phase 2 trial, investigators compared decitabine plus camrelizumab to camrelizumab alone. The trial included patients with relapsed/refractory classical Hodgkin lymphoma, who failed 2 or more prior therapies, and who had not previously had an anti-PD1 treatment.
A total of 19 patients received camrelizumab alone and 42 patients received decitabine plus camrelizumab. Patients were followed for a median of 34.5 months. The objective response rate (ORR) for monotherapy was 89%, with a 32% complete remission (CR) compared with 95% ORR and 79% CR in the combination therapy group (P <.001).
Female patients with smaller tumor burdens who had received fewer prior lines of therapy achieved a longer lasting remission with monotherapy.
The median PFS was 35 months in the combination therapy group compared with 15.5 months in the camrelizumab alone group (P =.02). Men, patients with larger tumor burdens, and those who had previous autologous stem cell transplant or received 3 or more prior therapies had better outcomes with combination therapy.
A total of 39 patients achieved a CR in the study, and 21 of those patients had a long-lasting CR and discontinued treatment. Of those patients, 15 were in the combination therapy group and 6 were in the monotherapy group.
The authors also found that patients with a higher percentage increase in peripheral T central memory cells who received combination therapy were more likely to have CR and prolonged PFS.
Overall, decitabine plus camrelizumab produced a duration of response and PFS benefit compared with camrelizumab alone.
Liu Y, Wang C, Li X, et al. Improved clinical outcome in a randomized phase II study of anti-PD-1 camrelizumab plus decitabine in relapsed/refractory Hodgkin lymphoma. J Immunother Cancer. 2021;9(4):e002347. doi:10.1136/jitc-2021-002347