Nivolumab plus chemo provides one-year PFS in 94 percent lymphoma patients

Ninety-four percent of advanced stage (3 or 4) classic Hodgkin lymphoma patients treated with nivolumab, a PD-1 checkpoint inhibitor plus AVD chemotherapy (N-AVD) had one-year progression-free survival (PFS), according to Phase III trial results.

This was compared with 86 percent of patients given brentuximab vedotin, a monoclonal antibody (mAb), and AVD (BV-AVD).

Nivolumab together with AVD chemotherapy is expected to become new standard for initial treatment for advanced stage disease in adolescents and adults, based on the trial data to be presented at 2023 American Society of Clinical Oncology (ASCO) Annual Meeting Plenary.

“The results are remarkable” commented Dr Alex Herrera, lead investigator on the study and Chief of the Division of Lymphoma at the City of Hope organisation in the US. The therapy offers “another effective and safe treatment option” for these patients, stated Herrera.

Brentuximab vedotin was the first antibody–drug conjugate (ADC) developed for classic Hodgkin lymphoma. Studies have demonstrated using the therapy as first-line treatment improves PFS and overall survival. 

The PD-1 checkpoint inhibitor combination therapy trial

Of a total of 976 eligible clinical trial patients, 489 were enrolled in the N-AVD arm (the PD-1 checkpoint inhibitor nivolumab plus Adriamycin, vinblastine and dacarbazine). Then 487 were part of the BV-AVD group. Each group received six infusion cycles of each combination therapy. The combination treatment was well-tolerated, with few serious immune-related side effects observed in the trial. 

Further results

Less than one percent of patients needed radiation after trial treatment, it was reported. This is a dramatic reduction in the proportion of patients being initially treated for Hodgkin lymphoma who need radiation, especially among paediatric patients.

“The ability to maintain high rates of relapse-free survival with minimal use of radiation therapy in children with newly diagnosed advanced stage Hodgkin lymphoma will be a paradigm shift,” suggested Dr Sharon Castellino, Chair of the COG Hodgkin lymphoma committee and Director of the Leukemia and Lymphoma Program at the Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Winship Cancer Institute at Emory University.

PD-1 checkpoint inhibitors block the PD-L1 protein to help the immune system and help T cells to eliminate cancer. In Phase III study, adding nivolumab to chemotherapy worked so well that some patients experienced remission after only a few treatments.

The Phase III study was titled ‘SWOG S1826, a randomized study of nivolumab(N)-AVD versus brentuximab vedotin(BV)-AVD in advanced stage (AS) classic Hodgkin lymphoma (HL)‘.