Children’s Wisconsin, Milwaukee, WI
Paul David Harker-Murray , Peter D. Cole , Bradford S. Hoppe , David C. Hodgson , Auke Beishuizen , Nathalie Garnier , Salvatore Buffardi , Maurizio Mascarin , Andrej Lissat , Alev Akyol , Russell Crowe , Ju Li , Richard A. Drachtman , Kara M Kelly , Thierry Leblanc , Stephen Daw
Background: Outcomes are poor for patients (pts) with cHL who develop R/R disease after first-line (1L) chemotherapy ± radiotherapy (RT). Salvage tx that attain high event-free survival (EFS) rates and minimize late toxicity by omitting high-dose chemotherapy (HDCT)/auto-HCT are needed. CheckMate 744 (NCT02927769) is the first multicenter phase 2 study evaluating a risk-stratified, response-adapted salvage tx with nivo + BV in CAYA with R/R cHL. In the standard-risk cohort, complete molecular response (CMR) rate before consolidation with HDCT/auto-HCT was 94% (Harker-Murray et al. Blood 2022). With highly active salvage tx, pts in low-risk cohort could achieve high EFS without HDCT/auto-HCT; we report data from this cohort. Methods: Pts were aged 5–30 y and had ≤ 3 cycles (C) of 1L anthracycline-based systemic tx. Risk stratification was described in Harker-Murray et al. Pts received 4C of nivo + BV induction. Pts with CMR received additional 2C nivo + BV before involved-site radiation therapy (ISRT) consolidation (dose, 30–30.6 Gy). Pts with suboptimal response received 2C BV + bendamustine intensification; pts with CMR proceeded to ISRT consolidation. Primary endpoints: CMR rate (Lugano 2014) any time before ISRT and 3-y EFS rate, both per blinded independent central review (BICR). For CMR and overall response rate (ORR), a 90% confidence interval (CI) was used per statistical plan. Results: Among 28 pts treated with nivo + BV, median (range) age was 17 (6–27) y; 64% of pts were aged < 18 y. Most (64%) pts had stage II disease at relapse; 82% had relapse ≥ 12 mo after 1L tx, 2 pts had prior RT. Median (range) follow-up was 31.9 (2.2–55.3) mo. CMR, ORR, 3-y EFS and PFS rates are shown in Table. Median duration of response was not reached; 87% of pts had sustained response at 36 mo’ follow-up. Efficacy outcomes were comparable in the pediatric population (CMR per BICR before ISRT, 88.9%; 3-y EFS rate, 78.3%). During induction, 22 (78.6%) pts had treatment-related adverse events (TRAEs; grade 3/4, 25.0% pts; hematologic, < 10% pts; immune-mediated, 21.4%). Serious AEs leading to discontinuation included rash, pyrexia, and acute kidney injury (1 pt each). Conclusions: The findings demonstrate that most CAYA with low-risk R/R cHL can be salvaged with chemoimmunotherapy with a favorable toxicity profile, and do not require HDCT/auto-HCT. Clinical trial information: NCT02927769.
BICR | INV | |
---|---|---|
Any time before ISRT | ||
CMR, n (%) [90% CI] | 26 (92.9) [79.2-98.7] | 25 (89.3) [74.6-97.0] |
ORR, n (%) | 28 (100.0) | 28 (100.0) |
After 4C nivo + BV | ||
CMR, n (%) | 23 (82.1) | 24 (85.7) |
ORR, n (%) [90% CI] | 27 (96.4) [84.1–99.8] | 28 (100.0) [89.9–100.0] |
3-y EFS, % [90% CI] | 86.9 [69.5–94.7] | 88.0 [71.8–95.2] |
3-y PFS, % [90% CI] | 95.0 [76.7–99.0] | 95.7 [79.4–99.1] |
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Abstract Disclosures
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