24 June 2020
EHA 2020 Congress - Classical Hodgkin Lymphoma
204 study – relapsed or refractory classical Hodgkin lymphoma
Robin Gasiorowski, Consultant Haematologist, Concord
Hematology Association (EHA) congress
Dr Robin Gasiorowski from Concord Hospital
spoke to Donna Gairns, National Nurse Director, Lymphoma Australia, about a
study that was presented during the recent European Hematology Association
(EHA) congress, held during 11-21 June 2020. This is the annual congress haematology meeting held each June across
Europe, and is attended by Australian and international experts each year. This year the meeting was held as a virtual
event due to COVID-19 restrictions.
Dr Robin Gasiorowski is one of the leading
investigators in Australia for the international clinical trial that has been
named KEYNOTE 204. It is a randomised
phase 3 trial that compared the overall outcomes and the side effect profile of
two therapies that are currently approved in the relapsed or refractory
classical Hodgkin lymphoma group: pembrolizumab and brentuximab vedotin.
The results found that the patients both
responded significantly better, but also found that the side effects were less
in the group who received pembrolizumab compared to the group who received
Through this study, it shows that
pembrolizumab is the preferred new standard of care for patients with relapsed
or refractory classical Hodgkin lymphoma.
Dr Gasiorowski also discussed the study
that looked at PET negative early-stage unfavourable Hodgkin lymphoma who had good
results when they received higher dose chemotherapy regimen for less cycles,
that omitted the need for radiotherapy to consolidate after treatment. This is good for young patients who receive
less toxic therapy and experience less late effects from treatment. This will provide clinicians with more
information to best inform treatment.
3, RANDOMIZED, OPEN-LABEL STUDY OF PEMBROLIZUMAB (PEMBRO) VERSUS BRENTUXIMAB
VEDOTIN (BV) FOR TREATMENT OF RELAPSED OR REFRACTORY CLASSICAL HODGKIN LYMPHOMA
POSITRON EMISSION TOMOGRAPHY GUIDED OMISSION OF RADIOTHERAPY IN EARLY-STAGE
UNFAVORABLE HODGKIN LYMPHOMA: FINAL RESULTS OF THE INTERNATIONAL, RANDOMIZED
PHASE III HD17 TRIAL BY THE GHSG
- Conclusion: PET4-negativity after treatment with “2+2”
chemotherapy in patients with newly diagnosed early-stage
MORE ABOUT THE KEYNOTE-204 STUDY
KEYNOTE-204: Randomized, Open-Label, Phase 3 Study of Pembrolizumab Versus Brentuximab Vedotin in Relapsed or Refractory Classical Hodgkin Lymphoma.
The KEYNOTE-204 phase 3 study of pembrolizumab versus brentuximab vedotin in relapsed or refractory classical Hodgkin lymphoma was presented at the European Hematology Association (EHA) annual congress in June 2020. It was presented by one of the lead investigators, Prof Luigi Zinzani. (Abstract LB2600)
Pembrolizumab is a PD-1 inhibitor used for relapsed or refractory classical Hodgkin lymphoma. It is currently funded in Australia for those who have relapsed (comes back) or refractory (does not respond to treatment). This is for patients who have received an autologous stem cell transplant (auto-SCT) or are found to be unsuitable for an auto-SCT.
Brentuximab vedotin is a drug conjugate (an immunotherapy and chemotherapy combined) that is used to treat classical Hodgkin lymphoma in the relapsed or refractory setting. This is funded in Australia if a patient has relapsed after auto-SCT or are found to be unsuitable for an auto-SCT.
KEYNOTE-204 was a randomised, international, open-label, phase III trial that looked at the outcomes of either using pembrolizumab (pembro) or brentuximab vedotin (BV) in relapsed or refractory classical Hodgkin lymphoma subtypes, as a single agent (monotherapy).
All suitable patients (300 in total) were either post an autologous stem cell transplant or were unsuitable for auto-SCT and had either relapsed or had refractory disease. The primary end point (the goal) of the trial was to see the progression free survival (PFS) or the length of time during and after the treatment before the disease progresses.
Roughly half of the patients who took part in the study were given pembro and the other half were given BV. Patients were followed up for a median (average) time of 24.7 months, the median progression, the PFS was 13.2 months with pembro versus 8.3 months with BV. This means that there is a 35% less risk of progression or death when using pembro compared to BV.
These results included those who had not had an auto-SCT, primary refractory disease, prior BV exposure and no exposure to BV. The adverse side effects of both of these drugs were the same as previously experienced when these therapies were used. Where patients had less overall grade 3-5 (more severe) side using pembro compared to using BV.
The results concluded that pembrolizumab should be the preferred treatment of choice or considered as the new standard of care for those with relapsed or refractory classical Hodgkin lymphoma, post auto-SCT or unsuitable for auto-SCT. The patients who received pembro showed better outcomes both with PFS and overall adverse side effects across all subgroups of patients.
For more information
For more information, please see the Lymphoma Australia interviews by Dr Robin Gasiorowski, Concord Hospital (Sydney) and Dr Michael Dickinson, Peter MacCallum Cancer Centre (Melbourne) who were both investigators on the study in Australia.