The combination of immunotherapy drug Opdivo (nivolumab) with standard chemotherapy has demonstrated remarkable efficacy in treating older patients with classical Hodgkin lymphoma (cHL), according to new research published in the Journal of Clinical Oncology.
In a groundbreaking phase 1/2 study, researchers evaluated the combination of Opdivo with doxorubicin, vinblastine, and dacarbazine (N-AVD) in patients aged 60 and older with newly diagnosed cHL. The results show promising outcomes despite patients presenting with various geriatric impairments.
Study Results and Survival Outcomes
After a median follow-up of 49 months among 37 response-evaluable patients, the treatment demonstrated impressive efficacy:
- Three-year progression-free survival rate: 79%
- Three-year overall survival rate: 97%
- For stage 3 or 4 disease patients: 80% progression-free survival at three years
Patient Demographics and Characteristics
The study population represented a diverse elderly cohort:
- Median age: 66 years
- 38% of participants were 70 or older
- 78% had stage 3 or 4 disease
- 68% had an International Prognostic Score of 3 or greater
- 82% were dependent in at least one daily living activity
- 40% were on more than 10 medications daily
Safety Profile and Tolerability
The treatment regimen showed manageable safety profiles, though careful monitoring was required:
- 50% of patients experienced grade 3 or 4 treatment-related side effects
- 10% discontinued treatment due to adverse events
- 8% experienced febrile neutropenia
- Endocrine immune-related side effects were predominantly mild to moderate
- Seven patients required systemic steroids for immune-related side effects
Treatment Protocol
The study administered six cycles of AVD at standard doses, combined with:
- 240 milligrams of Opdivo
- Intravenous administration every two weeks
- Treatment on days 1 and 15 of each cycle
Clinical Implications
The research team emphasized that the N-AVD combination "produces excellent outcomes for untreated older patients with cHL." Importantly, baseline geriatric impairments showed no correlation with survival outcomes or toxicities, suggesting the treatment's broad applicability across the elderly population.
Dr. Jonathan W. Friedberg, editor-in-chief of the Journal of Clinical Oncology, noted that pending confirmation from longer follow-up in the S1826 trial, this combination therapy could establish a new standard of care for most older patients with Hodgkin lymphoma.
During the study period, six patients experienced cHL relapse, and only one death occurred, which was attributed to COVID-19 pneumonia rather than the disease or treatment.
