Improved efficacy of concurrent anti-PD1 antibody plus AVD versus ABVD in patients with newly diagnosed early unfavorable and advanced stage classic Hodgkin lymphoma: a retrospective matched cohort study.

in Cancer immunology, immunotherapy : CII by Mengqiu Wu, Peng Sun, Baitian Zhao, Hang Yang, Yi Xia, Man Nie, Qingqing Cai, Huiqiang Huang, He Huang, Zhongjun Xia, Yu Wang, Zhiming Li, Panpan Liu

TLDR

  • This study compared the efficacy of anti-PD1-AVD and ABVD regimens in untreated cHL patients and found that anti-PD1-AVD had a significantly prolonged modified PFS and improved CR rate.
  • The results suggest that anti-PD1-AVD may be a more effective frontline therapy for cHL compared to traditional ABVD regimen.
  • Future studies are needed to confirm the results and establish the role of anti-PD1-AVD in clinical practice.

Abstract

The prognosis of early unfavorable and advanced stage classic Hodgkin lymphoma (cHL) remains suboptimal with the widely used ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) regimen. Novel agents such as brentuximab vedotin (BV) and anti-PD-1 antibody have demonstrated high efficacy and good tolerance in relapsed/refractory cHL and have also shown promising results in the frontline setting. However, concurrent administration of anti-PD-1 antibody plus AVD in comparison with traditional ABVD regimen alone in untreated classic Hodgkin lymphoma (cHL) has yet to be adequately studied in real-world clinical practice. We enrolled eligible adult patients with histologically confirmed cHL who had received initial treatment with the ABVD regimen, or the novel combination regimens of anti-PD1-AVD. The study endpoints included modified progression-free survival (mPFS) and complete response (CR) after 2 cycles of therapy. Propensity score matching (PSM) was performed to balance clinical variables between regimens prior to efficacy comparisons. Of 172 patients, 137 received the ABVD regimen and 35 received the anti-PD1-AVD regimen. With a median follow-up of 37.7 months, significantly prolonged 3-year modified PFS was reported for anti-PD1-AVD versus ABVD (PSM: 91.0 vs. 61.6%, p = 0.032). Significantly improved CR rate was observed with anti-PD1-AVD versus ABVD (PSM: 86.7 vs. 63.8%, p = 0.049). In this real-world study, concurrent anti-PD1 antibody with AVD showed significantly prolonged modified PFS and improved CR rate after cycle 2 versus ABVD regimen, supporting the use of novel agents in frontline therapy.

Overview

  • This study aims to compare the efficacy and safety of anti-PD-1 antibody combined with AVD (anti-PD1-AVD) to the traditional ABVD regimen in untreated classic Hodgkin lymphoma (cHL) patients.
  • The study enrolled 172 patients who received either ABVD or anti-PD1-AVD, and the primary endpoints were modified progression-free survival (mPFS) and complete response (CR) after 2 cycles of therapy.
  • The study used propensity score matching (PSM) to balance clinical variables between regimens prior to efficacy comparisons.

Comparative Analysis & Findings

  • The study found that anti-PD1-AVD had a significantly prolonged 3-year modified PFS compared to ABVD (91.0% vs. 61.6%, p = 0.032).
  • Significantly improved CR rate was observed with anti-PD1-AVD versus ABVD (86.7% vs. 63.8%, p = 0.049).
  • The results suggest that the novel combination of anti-PD1-AVD may be a more effective frontline therapy for cHL compared to traditional ABVD regimen.

Implications and Future Directions

  • The findings of this study support the use of novel agents, such as anti-PD1 antibody, in frontline therapy for cHL patients.
  • Future studies should investigate the long-term efficacy and safety of anti-PD1-AVD in cHL patients, as well as explore the optimal duration of treatment and potential combination with additional therapies.
  • Real-world evidence from larger studies will be important to confirm the results of this study and establish the role of anti-PD1-AVD in clinical practice.
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