City of Hope National Medical Center, Duarte, CA.
Memorial Sloan Kettering Cancer Center, New York, NY.
Blood. 2018 Mar 15;131(11):1183-1194. doi: 10.1182/blood-2017-10-811224. Epub 2017 Dec 11.
In this phase 1/2 study, brentuximab vedotin (BV) and nivolumab (Nivo) administered in combination were evaluated as initial salvage therapy in patients with relapsed or refractory (R/R) classical Hodgkin lymphoma (HL). Patients received up to 4 cycles of combination treatment, with BV administered on day 1 and Nivo on day 8 of the first cycle. For cycles 2 to 4, BV and Nivo were both administered on day 1. After study treatment, responses were evaluated by investigators per the 2014 Lugano classification, and patients could proceed to autologous stem cell transplantation (ASCT). Sixty-two patients were enrolled; the complete response rate among all treated patients (n = 61) was 61%, with an objective response rate of 82%. Before ASCT, adverse events (AEs) occurred in 98% of patients, mostly grades 1 and 2. Infusion-related reactions (IRRs) occurred in 44% of patients overall, with 41% of patients experiencing an IRR during at least 1 infusion of BV. Five patients (8%) were treated with systemic steroids for immune-related AEs. A reduction of peripheral T-cell subsets including regulatory T cells was observed after the first dose of BV, and reduced serum levels of thymus- and activation-regulated chemokine concurrent with an increase in proinflammatory cytokines and chemokines were seen after the first BV plus Nivo infusions. The combination of BV plus Nivo was an active and well-tolerated first salvage regimen, potentially providing patients with R/R HL an alternative to traditional chemotherapy. This trial was registered at www.clinicaltrials.gov as #NCT02572167.
在这项 1/2 期研究中,评估了 Brentuximab vedotin(BV)和 nivolumab(Nivo)联合作为复发或难治性(R/R)经典霍奇金淋巴瘤(HL)患者初始挽救治疗的效果。患者接受了最多 4 个周期的联合治疗,第 1 周期的第 1 天给予 BV,第 8 天给予 Nivo。第 2 至第 4 周期,BV 和 Nivo 均在第 1 天给予。在研究治疗后,研究者按照 2014 年卢加诺分类评估反应,患者可以进行自体干细胞移植(ASCT)。共入组 62 例患者;所有治疗患者(n=61)的完全缓解率为 61%,客观缓解率为 82%。在 ASCT 之前,98%的患者发生了不良反应(AE),大多数为 1 级和 2 级。总体而言,44%的患者发生了输注相关反应(IRR),其中 41%的患者在至少 1 次 BV 输注期间发生了 IRR。有 5 例(8%)患者因免疫相关 AE 接受了全身皮质类固醇治疗。在首次给予 BV 后,观察到外周 T 细胞亚群(包括调节性 T 细胞)减少,并且在首次给予 BV 加 Nivo 后,观察到胸腺激活调节趋化因子的血清水平降低,同时促炎细胞因子和趋化因子增加。BV 加 Nivo 的联合是一种有效且耐受良好的一线挽救方案,为 R/R HL 患者提供了一种替代传统化疗的方法。这项试验在 www.clinicaltrials.gov 上注册为 #NCT02572167。
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