Pembrolizumab Followed by AVD in Untreated Early Unfavorable and Advanced-Stage Classical Hodgkin Lymphoma
In a recent publication in the Journal Blood, in March 11, 2021, investigators report on the utility of pembrolizumab as part of upfront therapy in untreated early unfavorable and advanced age classic Hodgkin’s lymphoma. The efficacy of pembrolizumab in relapsed / refractory Hodgkin’s lymphoma is well-established. The investigators wanted to assess to complete metabolic response rate and safety of pembrolizumab monotherapy in newly diagnosed classic Hodgkin’s lymphoma.
A multicenter single-arm, a phase 2 investigator initiated trial of sequential pembrolizumab coupled with doxorubicin, vinblastine and dacarbazine was performed. Patient were least 18 years old with untreated, early, unfavorable or advanced stage disease. 30 patients were enrolled, 12 with unfavorable stage and 18 with advanced stage. Patients were treated with 3 cycles of monotherapy with pembrolizumab followed by the chemotherapy combination for 4-6 cycles. The number of cycles depending on the stage of the bulk.
After pembrolizumab monotherapy, 37% of patients demonstrated a complete metabolic response and an additional 25% of patients had a more than 90% reduction in metabolic tumor volume. After 2 cycles of chemotherapy, all patients had achieved a complete metabolic response. The response was maintained at the end of treatment. With a median follow-up of 22.5 months, (range 14.2 – 30.6 months), there were no changes in therapy, progressions or death. No patients received consolidation radiotherapy, including those with bulky disease. Therapy was well-tolerated per the investigators. Grade 1 rash was seen in 6 patients and grade 2 infusion reactions were seen in for patients. A single event of grade 4 transaminitis was reported which was reversible and there was 1 case of reversible Bell’s palsy.
The authors concluded “brief pembrolizumab monotherapy followed by AVD was both highly effective and safe in patients with newly diagnosed classic Hodgkin’s lymphoma, including those with bulky disease.”