ASH 2015 News: Emerging Approaches for Elderly Hodgkin Lymphoma Patients

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Topics include: Treatment

On location in Orlando, Florida, at the 2015 American Society of Hematology (ASH) conference, patient advocate Carol Preston and Dr. Christopher Yasenchak, from US Oncology Research, discuss encouraging news for Hodgkin lymphoma patients who are over 60 years old.  Listen as Dr. Yasenchak explains why 50 percent of older patients cannot tolerate current potent chemo side effects and the exciting new combination treatments in pre-clinical trial that offer, as Dr. Yasenchak says “a game-changing opportunity.”

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Carol Preston:

Hello everyone and welcome.  I'm Carol Preston.  I am at ASH, the American Society of Hematology meeting, the big blood cancer meeting in Orlando, Florida.  And lots of encouraging news for many blood cancer patients coming out of this meeting, including Hodgkin lymphoma. 

And I have an expert with me.  Would you please introduce yourself? 

Dr. Yasenchak:

Sure, Carol, thank you.  My name is Christopher Yasenchak, and I'm a medical oncologist with the Willamette Valley Cancer Institute in Eugene, Oregon.  I'm also the Associate Chair for Hematology Research with US Oncology Research.  

Carol Preston:

And when we think of Hodgkin lymphoma, from what I know and what I've read, that is the curable lymphoma, and so it surprised me that there's still work and research going on.  Can you explain what's happening, especially with elderly patients? 

Dr. Yasenchak:

Sure, Carol, absolutely.  So in younger patients, you're absolutely right.  Long-term care rates are about 80 to 90 percent.  Unfortunately, the intensive multiagent chemotherapy regimens that are required to achieve that are not well tolerated in older patients.  And so historically in patients who are older than age 60, long-term cure rates are more in the 50 percent range.  

There are significant toxicities related to, as you might expect, multiple medical co-morbidities, more physical status, etc.  The biology of the disease in some situations tends to be a bit different than in younger patients as well, and then this requires a different approach to therapy.  

Carol Preston:

So what is in the pipeline? 

Dr. Yasenchak:

So what we've actually been utilizing is an antibody drug conjugate against a protein called CD30.  CD30 is expressed on the outside of Hodgkin lymphoma cells, so this antibody essentially carries a chemotherapy drug, a very potent chemotherapy drug called brentuximab vedotin (Adcetris) to the Hodgkin lymphoma cells.  Once they bind to the outside of the lymphoma cell, they're taken inside of it.  The chemotherapy molecules, this drug called MMAE releases itself inside of the cell and kills it. 

Carol Preston:

But you're now adding something to that.  

Dr. Yasenchak:

We are.  So we've already published the initial experience with monotherapy using just this antibody drug conjugate as an infusion by vein once every three weeks for up to 16 cycles—very well tolerated, relatively modest toxicity or side effect profile, some numbness and tingling or sensory neuropathy.  Response rates were actually quite high, in the 90-plus percent range.  

Carol Preston:

Wow. 

Dr. Yasenchak:

Duration of response, however, wasn't quite what we had hoped for with average progression-free survival, so how long does it take for the disease to progress, of a little over 11 months.  

Carol Preston:

So what is your thinking?  How do you go forward now? 

Dr. Yasenchak:

So how we go forward then is try to add some other agents to that antibody drug conjugate that will be synergistic.  Can they multiply their effect on the cancer but still be well tolerated by patients? 

Carol Preston:

So you're looking for that combination magic bullet for the one?two punch?  

Dr. Yasenchak:

We are.  And so we've added an additional two cohorts to this study, the first using a chemotherapy drug called dacarbazine, or DTIC, which is also given by vein.  It is one of the components of the historical regimen we think of for Hodgkin lymphoma called ABVD, and so it's the D portion of that acronym.  Tends to be pretty well tolerated, and we have preclinical models showing significant synergy with this antibody drug conjugate called brentuximab vedotin, etc. 

Carol Preston:

So if you want to leave patients, especially elderly patients with Hodgkin lymphoma, what do you want to say to them? 

Dr. Yasenchak:

What I want to say to them is that that regimen had extremely high response rates, 100 percent, so right now what we're seeing is the duration of response, although it's not a randomized study, looks superior as well.  And so right now the 12?month progression?free survival is about 66 percent. 

Carol Preston:

The hope sounds palpable.  

Dr. Yasenchak:

It really does.  And so 85 percent of the patients who are enrolled in this study were not eligible for standard chemotherapy, significant co-morbidities.  The oldest patient treated on this study was age 92. 

Carol Preston:

Fantastic. 

Dr. Yasenchak:

So for patients even when they're feeling not well from their lymphoma, fevers, night sweats, unintentional weight loss, pain related to their cancer, etc., who historically may have been offered supportive care, hospice, maybe steroid medications like prednisone, and now they have an opportunity.  Clearly, I'm a bit biased, but in my opinion for a game?changing opportunity that they can deliver—that we can deliver to them in the community setting. 

Carol Preston:

Dr. Yasenchak, first of all, thank you for the work that you do, and we will look forward hopefully in the next year about hearing even more encouraging and hopeful news for Hodgkin lymphoma patients, especially elderly patients where it's tough to tolerate these potent chemotherapy regimens.  

I'm Carol Preston reporting from ASH.  Thank you for watching.  

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on January 7, 2016