Teens with advanced-stage Hodgkin lymphoma have better outcomes when treated with the immunotherapy nivolumab (Opdivo) in combination with chemotherapy, rather than brentuximab vedotin (Adcetris) and chemotherapy, according to a new analysis of a phase 3 clinical trial. The study was led by Kara Kelly, MD, from Roswell Park Comprehensive Cancer Center, and Sharon Castellino, MD, from the Aflac Cancer and Blood Disorders Center of Children’s Healthcare of Atlanta and Emory University School of Medicine.
The findings support lowering the minimum age for receiving nivolumab to 12 years old. As a result, the National Comprehensive Cancer Network (NCCN) has updated its guidelines to recommend combining nivolumab with AVD chemotherapy for adolescents newly diagnosed with stage 3-4 classic Hodgkin lymphoma.
“This was the first Hodgkin lymphoma clinical trial to enroll adolescents along with adults,” said Dr. Kelly. “They represented the largest cohort in which the use of a checkpoint inhibitor was evaluated as a first-line treatment in a pediatric population.”
The analysis examined 240 adolescents aged 12-17 within a larger group of 994 patients. Half received brentuximab vedotin plus AVD chemotherapy; the other half received AVD plus nivolumab. The three-year follow-up showed that 93% of teens in the nivolumab-AVD group had progression-free survival compared to 82% in the brentuximab vedotin-AVD group.
Dr. Kelly noted an important finding: fewer patients needed radiation therapy with this regimen. “Historically, 50-70% of pediatric patients with advanced-stage Hodgkin lymphoma require radiation, but this regimen slashed that to less than 1%,” she said. “We believe this will limit long-term side effects such as breast cancer and heart disease in these young patients.”
Patients receiving nivolumab also experienced fewer adverse side effects compared to those treated with brentuximab vedotin.
“The study indicates the ability for pediatric and adult oncologists to collaborate to safely accelerate the time to access novel therapies for teens with lymphoma by including them in trials with adult patients,” said Dr. Castellino.
The trial was sponsored by SWOG Cancer Research Network and included multiple institutions across North America. Funding came from grants provided by the National Cancer Institute and several foundations, while Bristol Myers Squibb and SeaGen supplied drugs used during the research.
