A new booster for Hodgkin lymphoma patients

Adding a known antibody-drug conjugate to a standard chemotherapy regimen may help overcome drug resistance, new research shows. 

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Scientists at KAIMRC have created a ‘supercharged’ cocktail that combines salvage chemotherapy treatment with targeted therapy for patients with recurrent Hodgkin lymphoma. 

The combination drug help patients stay in remission, the researchers say.  

Hodgkin lymphoma, a cancer that develops in the lymphatic system, is highly curable in 70-80% of patients. In some cases, lymphomas come back, or are resistant to treatment; the latter is referred to as refractory Hodgkin lymphoma. 

For patients with refractory or relapsed Hodgkin lymphoma, salvage chemotherapy — a treatment regimen that often employs a mix of three to four strong, sometimes highly toxic drugs — is often considered as a last-ditch measure.  

One of the more commonly used ‘salvage’ combination is IGEV— a mix of ifosfamide, gemcitabine and vinorelbine at high dosage, which has been reported to have a good response rate, meaning that the percentage of patients whose cancer has shrunk or disappeared after treatment is high. This particularly benefited autologous stem cell transplant patients, who use their own stem cells to replace damaged bone marrow and blood cells after chemotherapy, since their post-transplantation outcome, overall survival and remission rate are greatly dependent on the response rate.

To further improve the response rate of IGEV, Moussab Damlaj and colleagues at KAIMRC have now examined its efficacy when combined with targeted therapy using the monoclonal antibody–drug conjugate brentuximab vedotin. Monoclonal antibodies are substitute antibodies engineered from cloned immune cells.

Brentuximab vedotin has been widely used as the first line of treatment for Hodgkin lymphoma because it selectively targets and kills CD30-expressing cells, including Hodgkin lymphoma cells. 

The researchers analyzed records of 28 patients with relapsed or refractory Hodgkin lymphoma who had received brentuximab vedotin in addition to IGEV at KAIMRC between 2013 and 2017. Their preliminary results showed that the complete metabolic response rate — as indicated by positron emission tomography and computed tomography — after one or two cycles of treatment was 71%. 

All patients who received the cocktail had favourable post-transplantation outcomes. 

The experimental treatment, however, had side effects, the most common of which were problems related to the blood. Approximately 96% and 89% of patients had reported low neutrophil levels and low blood platelet counts, respectively. No patients were transferred to the intensive care unit or died during salvage chemotherapy.

References

  1. Eid, R. A., et al. Chemoimmunotherapy with brentuximab vedotin combined with ifosfamide, gemcitabine, and vinorelbine is highly active in relapsed or refractory classical Hodgkin lymphoma. Bone Marrow Transplantation 54, 1168–1172(2019). | article

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