Division of Hematology and Medical Oncology, Perlmutter Cancer Center at NYU Langone Health, New York, New York, USA.
Department of Medicine, New York University School of Medicine & Langone Medical Center, New York, New York, USA.
Oncologist. 2020 Oct;25(10):878-885. doi: 10.1634/theoncologist.2020-0167. Epub 2020 Aug 28.
Targeted therapies and checkpoint blockade therapy (CBT) have shown efficacy for patients with Hodgkin lymphoma (HL) in the relapsed and refractory (R/R) setting, but once discontinued owing to progression or side effects, it is unclear how successful further therapies will be. Moreover, there are no data on optimal sequencing of these treatments with standard therapies and other novel agents. In a multicenter, retrospective analysis, we investigated whether exposure to CBT could sensitize HL to subsequent therapy.
Seventeen centers across the U.S. and Canada retrospectively queried medical records for eligible patients. The primary aim was to evaluate the overall response rate (ORR) to post-CBT treatment using the Lugano criteria. Secondary aims included progression-free survival (PFS), duration of response, and overall survival (OS).
Eighty-one patients were included. Seventy-two percent had stage III-IV disease, and the population was heavily pretreated with a median of four therapies before CBT. Most patients (65%) discontinued CBT owing to progression. The ORR to post-CBT therapy was 62%, with a median PFS of 6.3 months and median OS of 21 months. Post-CBT treatment regimens consisted of chemotherapy (44%), targeted agents (19%), immunotherapy (15%), transplant conditioning (14%), chemotherapy/targeted combination (7%), and clinical trials (1%). No significant difference in OS was found when stratified by post-CBT regimen.
In a heavily pretreated R/R HL population, CBT may sensitize patients to subsequent treatment, even after progression on CBT. Post-CBT regimen category did not impact OS. This may be a novel treatment strategy, which warrants further investigation in prospective clinical trials.
Novel, life-prolonging treatment strategies in relapsed and refractory (R/R) Hodgkin lymphoma (HL) are greatly desired. The results of this multicenter analysis concur with a smaller, earlier report that checkpoint blockade therapy (CBT) use in R/R HL may sensitize patients to their subsequent treatment. This approach may potentially enhance therapeutic options or to bridge patients to transplant. Prospective data are warranted prior to practice implementation. As more work is done in this area, we may also be able to optimize sequencing of CBT and novel agents in the treatment paradigm to minimize treatment-related toxicity and thus improve patient quality of life.
针对复发/难治性（R/R）霍奇金淋巴瘤（HL）患者，靶向治疗和检查点阻断治疗（CBT）已显示出疗效，但由于进展或副作用而停药后，尚不清楚进一步治疗的成功率如何。此外，尚无数据表明这些治疗方法与标准治疗和其他新型药物的最佳治疗顺序。在一项多中心回顾性分析中，我们研究了 CBT 暴露是否能使 HL 对后续治疗更敏感。
美国和加拿大的 17 个中心回顾性查询了合格患者的病历。主要目的是根据卢加诺标准评估 CBT 后治疗的总体缓解率（ORR）。次要目标包括无进展生存期（PFS）、反应持续时间和总生存期（OS）。
共纳入 81 例患者。72%的患者为 III-IV 期疾病，且人群在接受 CBT 前接受了中位数为 4 种治疗的大量预处理。大多数患者（65%）因进展而停止 CBT。CBT 后治疗的 ORR 为 62%，中位 PFS 为 6.3 个月，中位 OS 为 21 个月。CBT 后治疗方案包括化疗（44%）、靶向药物（19%）、免疫治疗（15%）、移植预处理（14%）、化疗/靶向联合（7%）和临床试验（1%）。按 CBT 后方案分层，OS 无显著差异。
在接受大量预处理的 R/R HL 人群中，CBT 可能使患者对后续治疗更敏感，即使在 CBT 进展后也是如此。CBT 后方案类别不影响 OS。这可能是一种新的治疗策略，值得在前瞻性临床试验中进一步研究。
在复发/难治性（R/R）霍奇金淋巴瘤（HL）中，迫切需要新的、延长生命的治疗策略。这项多中心分析的结果与一项规模较小、较早的报告一致，即 CBT 在 R/R HL 中的使用可能使患者对后续治疗更敏感。这种方法可能潜在地增强治疗选择或为患者提供移植的机会。在实施实践之前，需要有前瞻性数据。随着该领域的进一步研究，我们还可以优化 CBT 和新型药物在治疗模式中的治疗顺序，以最大程度地减少治疗相关毒性，从而提高患者的生活质量。
