According to research published in Blood, response-adapted sequential salvage therapy with nivolumab or nivolumab followed by nivolumab in combination with ifosfamide, carboplatin, and etoposide (NICE) was well tolerated and efficacious in patients with relapsed/refractory (R/R) classical Hodgkin lymphoma (cHL), allowing most patients to bridge to autologous hematopoietic stem cell transplantation (ASCT) without the use of chemotherapy.

In the multicenter phase 2 trial (ClinicalTrials.gov Identifier: NCT03016871), the researchers administered adult patients with initial R/R cHL nivolumab (240 mg) every 2 weeks for up to 6 cycles (C). After C6, patients with CR proceeded to ASCT, while those with progressive disease at any point or not in CR received NICE for 2 cycles. The primary endpoint was CR rate (per 2014 Lugano classification).

A total of 43 participants (60% male), with a median age of 35 years (range, 18-70), enrolled in the study. Response was evaluable in 42 patients. After nivolumab monotherapy, the ORR was 81%, and the CR rate was 71%. A total of 9 patients received NICE; all responded, and 8 (89%) patients achieved CR. At completion of protocol therapy, the ORR and CR rates were 93% and 91%, respectively. Most patients (77%) were bridged directly to ASCT, including 26 (60%) after nivolumab monotherapy.


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In all patients, the 2-year progression-free survival (PFS) and overall survival (OS) rates were 72% and 95%, respectively. Among patients who bridged directly to AHCT, the 2-year PFS and OS were 94% and 97%.

Toxicity was evaluable in 43 patients, 34 who received nivolumab alone and 9 who received nivolumab and NICE. The researchers reported no unexpected toxicities after nivolumab or NICE.

“PET-adapted sequential Nivo/NICE salvage therapy was a safe and effective bridge to [ASCT] that resulted in a high rate of durable remissions in patients who proceeded to [ASCT],” the researchers wrote in their report. “Our findings along with the promising results observed in other studies incorporating PD-1 blockade into salvage therapy for cHL suggest that a randomized comparison of conventional vs anti-PD-1-based salvage therapy should be performed.”

Disclosure: This research was supported by Bristol-Myers Squibb. Please see the original reference for a full list of disclosures.

Reference

Mei MG, Lee HJ, Palmer JM, et al. Response-adapted anti-PD-1-based salvage therapy for Hodgkin lymphoma with nivolumab alone or in combination with ICE. Blood. 2022;139(25):3605-3616. doi:10.1182/blood.2022015423