The 24th National Conference on Clinical Oncology and the 2021 CSCO Annual Conference were held on September 25-29, 2021, with the theme of "Focusing on Innovative Research and Leading the Original Future". The conference continues to uphold CSCO
The fundamental purpose is to actively carry out academic exchange activities in a new form in a special period, promote academic exchanges and scientific and technological cooperation in the field of clinical oncology in China, encourage and support clinical research and innovation, advocate precision oncology on the basis of multidisciplinary standardized comprehensive treatment, and actively promote the development of disciplines. This time
At the CSCO conference, Professor Cao Junning of the Affiliated Cancer Hospital of Fudan University gave a report on the theme of "Treatment Progress of Hodgkin Lymphoma (HL)", and the main contents of TheRapy Pulse were sorted out as follows.
Professor Cao Junning first introduced the current status of treatment of HL. For the initial treatment of low-risk HL, abvD regimen combined with radiation therapy to the affected site provides cure for most patients. For the initial treatment of high-risk HL, there is still room for improvement in the safety of the commonly used BEACOPP scheme. At present, the research direction of the initial treatment of HL is to reduce the intensity of treatment and reduce the long-term adverse reactions of HL patients.
At present, the preferred treatment regimen for relapsed refractory (R/R) HL is conventional salvage chemotherapy combined with autologous hematopoietic stem cell transplantation (ASCT), and in recent years, the emergence of new drugs and new therapies such as vibutuximab (BV), PD-1 monoclonal antibody, chimeric antigen receptor T cell (CAR-T) immunotherapy has brought new treatment options to patients with R/R HL.
Treatment of stage I/II low-risk HL at the initial stage
Professor Cao Junning then introduced the treatment progress of primary treatment of stage I/II low-risk HL. The HD10 study conducted by the Hodgkin Lymphoma Research Group (GHSG) in Germany explored the effect of cycles of the ABVD regimen and the dose of radiation therapy on the prognosis of patients with HL. The results of the study showed that the 2-cycle ABVD regimen combined with 20Gy of radiotherapy was similar to that of other treatment regimens, and the safety was better, making it a better treatment choice for patients with low-risk HL at the first stage.
Mid-term PET-CT evaluation is important for guiding HL treatment strategies. The RAPID study compared the efficacy of 30Gy involved wild radiotherapy versus no radiotherapy in HL patients who tested negative for midterminal PET-CT. The results of the study showed that patients receiving radiotherapy had higher 3-year PFS rates, but there was no significant difference in 3-year OS rates between the two groups. The results of the EORTC/LYSA/FIL H10 study also showed that omitting radiation therapy in HL patients who tested negative for PET-CT in the medium term could lead to an increased probability of recurrence in the early (<2 years). Radiotherapy is still necessary for the initial treatment of low-risk patients with cHL.
Treatment of high-risk HL in stage I/II at the initial stage
The HD14 study compared the efficacy of a 4-cycle ABVD regimen and a 2-cycle enhanced BEACOPP regimen combined with a 2-cycle ABVD regimen in patients with initial treatment of high-risk HL. The results of the study showed that the 2-cycle enhanced BEACOPP regimen combined with the 2-cycle ABVD regimen was more effective, but the regimen also brought more adverse effects to HL patients.
At present, some studies are exploring the efficacy of new drugs in the initial treatment of high-risk HL. The Phase II NIVAHL study explored two first-line HL treatment strategies based on PD-1 monoclonal antibody navulisizumab, which included early-stage high-risk HL patients aged 18-60 years who were randomly assigned to receive 4 cycles of navuliyuzumab plus AVD regimen, or 4 doses of navuliliyuzumab prophase therapy, followed by 2 cycles of navuliyultab plus AVD regimen and 2 cycles of standard-dose AVD regimen. Subsequently, both groups of patients received radiation therapy to the affected site of 30 Gy. The results of the study showed that the navulilizumab plus AVD regimen achieved a high early CR rate in the initial treatment of high-risk HL, while the safety was acceptable. The prospect of immunotherapy drugs in the treatment of high-risk HL in the initial treatment of phase I/II is worth looking forward to.
Treatment of stage III/IV HL at the initial stage
The results of the HD9 study showed that the BEACOPP regimen could provide better efficacy in patients with stage III/IV HL than the ABVD regimen. The SWOG S0816 study also showed that enhancing the BEACOPP regimen improved prognosis for HL patients who tested positive for PET-CT after 2 cycles of ABVD regimen. However, it should be noted that the incidence of secondary primary tumors in HL patients after treatment with the BEACOPP regimen reaches 14%, and the management of long-term adverse reactions should be paid attention to when treating patients with HL with this regimen.
For patients with stage III/IV HL, BV is also a better treatment. The ECHELON-1 study compared the efficacy and safety of the BV-AVD regimen and the ABVD regimen in patients with Phase III/IV HL. The results of the study showed that the BV-AVD regimen reduced the risk of disease progression and death in patients with stage III/IV HL compared with the ABVD regimen, and was a better treatment option for patients with stage III/IV HL.
Treatment of R/RHL
New drugs such as BV and PD-1 monoclonal antibodies have also shown considerable efficacy in R/RHL. The KEYNOTE-204 study compared the efficacy of PD-1 monoclonal antibody, paborizumab, and BV in patients with R/RHL. The results showed that the PFS of pambolizumab in the treatment of R/RHL was significantly longer (median PFS: 13.2 months vs 8.3 months; P=0.0027) compared with BV.
The efficacy of BV plus chemotherapy regimens (e.g., BV-ICE regimen or BV combined with bendamustine regimen) in patients with R/RHL is also of concern, and the ORR of BV combined chemotherapy regimen for R/RHL in relevant studies is higher than 90%, and the PFS rate is higher than 65%. In addition, the "chemotherapy-free regimen" of BV with PD-1 monoclonal antibody reduces adverse effects in patients with R/RHL and is also a viable option for the treatment of patients with R/RHL.
Although the research progress of CAR-T therapy in R/RHL is relatively lagging behind that of B-cell lymphoma, CD30 CAR-T therapy has shown considerable initial efficacy in R/RHL in related studies. Follow-up studies are expected to further validate the efficacy of CD30 CAR-T therapy in R/RHL, providing new treatment options for patients with R/RHL who have failed treatment with BV, PD-1 monoclonal antibody, ASCT or allogeneic hematopoietic stem cell transplantation.
summary
Professor Cao Junning concluded: At present, the research direction of the initial treatment of HL is to reduce the long-term adverse reactions caused by treatment. Mid-term PET-CT evaluation is important for guiding HL treatment strategies. New drugs such as BV and PD-1 monoclonal antibodies have shown considerable efficacy in the treatment of HL, which has further enriched the treatment options of HL. The efficacy of CD30 CAR-T therapy in R/RHL needs to be further verified by subsequent studies.
Professor Cao Junning
Deputy Director of the Department of Oncology, Department of Oncology, Fudan University Affiliated Cancer Hospital, deputy chief expert of lymphoma multidisciplinary
Chairman of the Lymphoma Professional Committee of Shanghai Anti-Cancer Association
Standing Committee Member of Lymphoma Professional Committee of Chinese Anti-Cancer Association
Standing Committee Member of the Anti-Lymphoma Alliance of the Chinese Society of Clinical Oncology
Director of the Chinese Society of Clinical Oncology
Member of the Tumor Clinical Chemotherapy Professional Committee of the Chinese Anti-Cancer Association
Member of the Lymphatic Blood Group of the Oncology Branch of the Chinese Medical Association
Member of the Anti-Tumor Drugs Professional Committee of the Chinese Pharmaceutical Association
Vice Chairman of the Oncology Branch of the China Association for the Promotion of International Exchange in Healthcare
Vice Chairman of the Lymphoma Professional Committee of the Chinese Geriatric Health Care Association
Member of the Expert Committee on the Evaluation of The Quality and Efficacy of Generic Drugs of the State Food and Drug Administration