Hematologic Oncology Update, Issue 1, 2016 (Video Program)Brentuximab vedotin as initial salvage treatment on first relapse in HL
2:19 minutes.
TRANSCRIPTION:
DR YOUNES: The standard of care as of today involves multiagent chemotherapy. And if you achieve a complete remission, preferably PET-negative CR, then you go into autologous transplant. And the most widely used conditioning regimen is BEAM conditioning regimen. There’s not a randomized trial comparing different salvage regimens for Hodgkin lymphomas, so it’s a preference. Some people use ICE, which is fine. Some people use DHAP or DAP. Some people use GDP. They all probably give you the same quality of responses. DR LOVE: Could you talk about the work that’s been done at Memorial and also other places looking at the issue of brentuximab vedotin in that space to try to get patients to a PET-negative response? DR YOUNES: So currently, brentuximab vedotin is approved for patients who fail to respond after 2 lines of therapy. Therefore, some would call them transplant ineligible. And then you can use single-agent brentuximab in that indication. And if the patient responds, some of them could be converted to transplant eligibility. There’s interest now in moving brentuximab earlier in the line of treatment strategies and incorporated with standard chemotherapy. One approach is to use brentuximab first and then only if you don’t achieve a complete remission with brentuximab as single agent, then you add chemotherapy. So this would be called like a chemotherapy-sparing approach — try to spare the patients the chemotherapy. If you achieve a CR with brentuximab vedotin, you can move forward directly into autologous stem cell transplant. And that’s the approach that’s been done almost at the same time at Memorial and at the City of Hope, with slightly different treatment designs. So at Memorial, patients would have been given brentuximab vedotin alone for 2 to 3 cycles. And if you achieve PET-negative CR, then you can move forward with the autologous stem cell transplant. Using this strategy, you can achieve a CR rate in 30% of the patients. So 30% of the patients could be spared chemotherapy and move forward to transplant. DR LOVE: And is that what you do in your practice outside a trial setting? DR YOUNES: Not for now, no. It’s not a standard of care yet, but it is an option if patients really want or there’s medical indication for sparing chemotherapy. |