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Nivolumab for Untreated Advanced Classic Hodgkin Lymphoma

Hodgkin lymphoma cells.

Nivolumab (Opdivo®, Bristol-Myers Squibb), an anti–programmed cell death protein 1 (anti–PD-1) monoclonal antibody, has been previously approved by the FDA for the treatment of refractory classic Hodgkin lymphoma (cHL). Now, in the CheckMate 205 phase 2 clinical trial, nivolumab shows promise in newly diagnosed advanced-stage cHL.

In addition to refractory cHL, nivolumab is approved for the treatment of advanced lung cancer, melanoma, advanced kidney cancer, head and neck squamous cell cancer, advanced liver cancer, advanced bladder cancer, and colorectal cancer. This immunotherapy works by blocking the interaction between PD-1 and the ligands PD-L1 and PD-L2. These proteins are then unable to bind to receptors found on T cells, inhibiting T cell proliferation and cytokine production and in turn causing decreased tumor growth.

For this study, published in Journal of Clinical Oncology, 51 adult patients with treatment-naive, advanced-stage cHL with an Eastern Cooperative Oncology Group performance status of 0 to 1 and hemoglobin-adjusted diffusing capacity of the lung for carbon monoxide over 60% were administered four doses of nivolumab monotherapy followed by 12 doses of nivolumab plus doxorubicin, vinblastine, and dacarbazine (N-AVD). The nivolumab dose was administered intravenously at 240 mg, and all doses were received every two weeks.

At a median follow-up of 11.1 months, 59% of patients had experienced a grade 3 to 4 treatment-related adverse event, the most common being neutropenia, which affected 49% of patients. The objective response rate was 84%, with 67% of patients attaining complete remission. Patients with higher-level Hodgkin Reed-Sternberg PD-L1 expression were shown to have more encouraging responses to N-AVD therapy.

The study authors conclude, "Nivolumab followed by N-AVD was associated with promising efficacy and safety profiles for newly diagnosed, advanced-stage cHL."

For More Information

Ramchandren R, Domingo-Domenech E, Rueda A, et al (2019). Nivolumab for newly diagnosed advanced-stage classic Hodgkin lymphoma: safety and efficacy in the phase II CheckMate 205 study. J Clin Oncol. [Epub ahead of print] DOI:10.1200/JCO.19.00315

Image Courtesy of Creative Commons. Licensed Under CC BY-SA 4.0

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