Phase II Trial of Nivolumab Plus Doxorubicin, Vinblastine, Dacarbazine as Frontline Therapy in Older Adults With Hodgkin Lymphoma
Abstract
PURPOSE We conducted a phase I/II study evaluating nivolumab plus doxorubicin, vinblastine, dacarbazine (N-AVD) as frontline therapy for treatment-naïve older adults (OA) with classical Hodgkin lymphoma (cHL; ClinicalTrials.gov identifier: NCT03033914 ). METHODS Patients age ≥60 years with newly diagnosed, any stage, cHL were treated with six cycles of AVD at standard doses plus nivolumab 240 mg intravenously once every 2 weeks (on days 1 and 15) of each cycle. A geriatric assessment was performed before therapy initiation. The primary end point was progression-free survival (PFS). RESULTS Patient characteristics (N = 40) included median age of 66 years (range, 60-78 years) with 38% ≥70 years, 78% with stage III/IV disease, 68% with International Prognostic Score of ≥3, 82% dependent in ≥1 activities of daily living, 23% dependent in ≥1 instrumental activities of daily living, 50% with impaired timed up and go test, and 40% with polypharmacy. Among 37 response-evaluable patients, the median follow-up was 49 months and 3-year PFS and overall survival (OS) were 79% and 97%, respectively. Overall, 50% patients experienced grade 3/4 treatment-related adverse events (TRAEs), including febrile neutropenia in 8%. Four (10%) patients stopped therapy due to TRAEs. There was no correlation between baseline geriatric impairments and survival outcomes or toxicities. Positron emission tomography-2 was not predictive of PFS or OS. CONCLUSION N-AVD is a highly effective and well-tolerated frontline regimen in OA with cHL across a wide range of geriatric impairments.
Article Details
Journal Info
Journal of Clinical Oncology
Lippincott Williams & Wilkins
Authors (37)
Pallawi Torka
1memorial Sloan Kettering, NYC, United States
Tatyana Feldman
4John Theurer Cancer Center, Hackensack Meridian Health, Hackensack, United States
Kerry J. Savage
6BC Cancer, Vancouver, BC, Canada
Nivetha Ganesan
3Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
Esther Drill
1Memorial Sloan Kettering Cancer Center, New York, United States
Helen Hancock
1Memorial Sloan Kettering Cancer Center, Department of Medicine, Lymphoma Service, New York City, United States
Theresa Davey
1Memorial Sloan Kettering Cancer Center, New York, United States
Leslie Perez
Memorial Sloan Kettering Cancer Center, New York, NY
Charisse Capadona
Memorial Sloan Kettering Cancer Center, New York, NY
Sarima Subzwari
Memorial Sloan Kettering Cancer Center, New York, NY
Natasha Galasso
1Memorial Sloan Kettering Cancer Center, Lymphoma Service, New York, United States
Jinshu Yang
BC Cancer Agency, Vancouver, British Columbia, Canada
Michelle Post
BC Cancer Agency, Vancouver, British Columbia, Canada
Alexander Boardman
1memorial Sloan Kettering, NYC, United States
Philip Caron
1memorial Sloan Kettering, NYC, United States
Kevin David
1Memorial Sloan-Kettering Cancer Center, Medicine, Lymphoma Service, NEW YORK, United States
Zachary Epstein-Peterson
1Memorial Sloan Kettering Cancer Center, New York, United States
Lorenzo Falchi
Memorial Sloan Kettering Cancer Center, New York
Paola Ghione
4Memorial Sloan Kettering Cancer Center, New York, NY
Paul Hamlin
1memorial Sloan Kettering, NYC, United States
Steven M. Horwitz
Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
Andrew M. Intlekofer
Memorial Sloan Kettering Cancer Center, New York, NY
William Johnson
1memorial Sloan Kettering, NYC, United States
Anita Kumar
1memorial Sloan Kettering, NYC, United States
Jennifer Lue
1memorial Sloan Kettering, NYC, United States
Ariela Noy
2Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
Colette Owens
1Memorial Sloan Kettering Cancer Center, New York, United States
M. Lia Palomba
5Memorial Sloan Kettering Cancer Center, New York, NY
Gilles A. Salles
Memorial Sloan Kettering Cancer Center, New York, New York, United States
Raphael Steiner
Robert Stuver
3Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
Santosha Vardhana
1Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, United States
Joachim Yahalom
1memorial Sloan Kettering, NYC, United States
Ahmet Dogan
Hematopathology Service, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York
Andrew D. Zelenetz
11Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
Heiko Schoder
1memorial Sloan Kettering, NYC, United States
Alison J. Moskowitz
3Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY