Response-adapted therapy (tx) with nivolumab plus brentuximab vedotin (nivo + BV) without autologous hematopoietic cell transplantation (auto-HCT) in children, adolescents, and young adults (CAYA) with low-risk relapsed/refractory (R/R) classic Hodgkin lymphoma (cHL): CheckMate 744.

Authors

null

Paul David Harker-Murray

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

Organizations

Children’s Wisconsin, Milwaukee, WI, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, Mayo Clinic, Jacksonville, FL, Princess Margaret Cancer Centre, Toronto, ON, Canada, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands, Institut d’hematologie et d’oncologie pediatrique, CHU de Lyon, Lyon, France, Santobono-Pausilipon Hospital, Naples, Italy, AYA Oncology and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico IRCCS, Aviano, Italy, Charite Universitats Medizin, Berlin, Germany, Bristol Myers Squibb, Princeton, NJ, Bristol Myers Squibb, Boudry, Switzerland, Roswell Park Comprehensive Cancer Center and University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, Hôpital Robert-Debré APHP, Paris, France, University College Hospital, London, United Kingdom

Research Funding

Pharmaceutical/Biotech Company
Bristol Myers Squibb

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.

CMR and ORR per BICR and investigator (INV) in low-risk cohort.

BICRINV
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 Details

Meeting

2023 ASCO Annual Meeting

Session Type

Poster Discussion Session

Session Title

Hematologic Malignancies—Lymphoma and Chronic Lymphocytic Leukemia

Track

Hematologic Malignancies

Sub Track

Hodgkin Lymphoma

Clinical Trial Registration Number

NCT02927769

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr 7515)

DOI

10.1200/JCO.2023.41.16_suppl.7515

Abstract #

7515

Poster Bd #

66

Abstract Disclosures