Nivolumab may represent an important treatment strategy for patients with relapsed or refractory classical Hodgkin lymphoma (HL), and may be prescribed as a retreatment among those who develop adverse events, according to research published in the American Journal of Blood Research.1
Patients with chemotherapy-refractory HL who do not benefit from autologous stem cell transplantation (ASCT) have a poor prognosis. Although nivolumab, a checkpoint inhibitor targeting PD-1, is approved for patients with relapsed/refractory HL who fail ASCT and brentuximab vedotin, this immunotherapy is more frequently viewed as a bridging therapy to allogeneic SCT than a standalone therapy.
There is, furthermore, data suggesting that nivolumab may lead to severe immune-related adverse events in this patient population, particularly after allo-SCT. Data suggest that these patients may develop severe and refractory graft vs host disease, a life-threatening complication linked with transplantation. There is, however, no conclusive evidence as to whether nivolumab provides an overall survival benefit among these patients.
The authors of the present paper argued that, among those with HL who develop severe immune-related adverse events with nivolumab, patients may be rechallenged after ASCT consolidation. One patient treated at a practice in Italy upon whom this strategy was used had an ongoing complete response at least 20 months post-rechallenge. The authors also noted the experiences of other practices, which have had similar results with nivolumab retreatment.
A study prescribed nivolumab 40 mg every 2 weeks in a group of 30 patients with relapsed/refractory HL.2 The complete response rate noted was 43.3%, and the median progression-free survival was 18.4 months. A total of 4 of the 30 patients, however, had a grade 3-4 adverse event.
“In conclusion, nivolumab has undoubtedly improved the prognosis of [relapsed/refractory] HL, especially in chemo-refractory patients or in cases who failed ASCT,” the authors wrote. “We believe that this drug should not only represent a bridge to allo-SCT, but it may play an important role also beyond the approved indication and current standard clinical care.”
- Cencini E, Bocchia M, Fabbri A. Nivolumab in relapsed/refractory Hodgkin lymphoma: towards a new treatment strategy? Am J Blood Res. 2021;11(3):261-265.
- Lepik KV, Fedorova LV, Kondakova EV, et al. A phase 2 study of nivolumab using a fixed dose of 40 mg (Nivo40) in patients with relapsed/refractory Hodgkin lymphoma. Hemasphere. 2020;4(5):e480. doi:10.1097/HS9.0000000000000480