Effectiveness of chemotherapy after anti-PD-1 blockade failure for relapsed and refractory Hodgkin lymphoma.

Abstract

Programmed death-1 (PD1) blockade is an efficient and safe therapeutic option in patients with relapsed/refractory (R/R) classical Hodgkin lymphoma (cHL). However, a substantial proportion of patients' progresses or loses the response to anti-PD1 treatment. We retrospectively investigated the effectiveness of salvage chemotherapies (CHT) for unsatisfactory response to anti-PD1, in 25 R/R cHL patients. Twenty-three patients (92%) were refractory to the last treatment before anti-PD1. After a median of 14 cycles (range 3-52), 68% (17/25) of patients had unsatisfactory responses to anti-PD1 therapy, whereas 6 had a partial response (PR) and 2 patients achieved complete response (CR), with an overall response rate (ORR) of 32%. After a median time of 1.5 months, 15 patients received a single agent treatment and 10 had a multi-agents regimen, due to the failure of PD1 blockade. The ORR was 60% (8 CR and 7 PR). Seven patients (3 in PR and 4 in CR) underwent a consolidation strategy with stem cell transplantation. Median progression-free survival (PFS) with salvage treatment was reached at 19.1 months, while median PFS after anti-PD1 has been reached at 8.2 months. After a median follow-up of 32.4 months, 6 patients died while 13 are still in CR. The median overall estimated from the start of CHT was not reached. The efficacy of treatment following anti-PD1 is not yet established, especially in lymphoma patients. To note, in our series, a subset of heavily pre-treated and chemo-refractory patients increased response rates to and survival with CHT given after exposure to immune-checkpoint inhibitors.

• Authors: Beatrice Casadei, Lisa Argnani, Alice Morigi, Ginevra Lolli, Alessandro Broccoli, Cinzia Pellegrini, Laura Nanni, Vittorio Stefoni, Paolo E Coppola, Matteo Carella, Michele Cavo, Pier Luigi Zinzani
• Journal: Cancer medicine (Cancer Med) Vol. 9 Issue 21 Pg. 7830-7836 (11 2020) ISSN: 2045-7634 [Electronic] United States
• PMID: 32881376 (Publication Type: Journal Article)
• Copyright: © 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Chemical References

• Immune Checkpoint Inhibitors
• PDCD1 protein, human
• Programmed Cell Death 1 Receptor

Topics

• Adolescent
• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Drug Substitution
• Female
• Hodgkin Disease (diagnosis, drug therapy, immunology)
• Humans
• Immune Checkpoint Inhibitors (adverse effects, therapeutic use)
• Male
• Middle Aged
• Programmed Cell Death 1 Receptor (antagonists & inhibitors)
• Progression-Free Survival
• Retrospective Studies
• Salvage Therapy
• Time Factors
• Treatment Failure
• Young Adult