Treating Hodgkin Lymphoma: New Treatments on the Horizon

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Topics include: Treatment

Host Andrew Schorr catches up with expert Dr. Stephen Ansell, leader of the Lymphoma Group at Mayo Clinic in Rochester, Minnesota, at the 2017 ASCO meeting in Chicago to discuss updates on Hodgkin lymphoma. Although new data and updates for Hodgkin lymphoma weren't quite ready in time for the ASCO meeting, Dr. Ansell says there is still exciting news in the near future, stating, "I think this is a time for patients to have a lot of optimism and a lot of hope because I think there are more and more patients that are benefiting with less and less aggressive treatment." He also discusses new and approved therapies available for those living with Hodgkin lymphoma.

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Transcript

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. 

Andrew Schorr:

Hello and welcome to Patient Power.  I'm Andrew Schorr on location in Chicago at the American Society of Clinical Oncology meeting, ASCO, and I'm with someone who has been with us before, Dr. Stephen Ansell, who is Chair of the Department of Lymphoma—did I get it right? 

Dr. Ansell:

Sure.  The lymphoma group, yes. 

Andrew Schorr:

The lymphoma group at the Mayo Clinic in Rochester, Minnesota, and we wanted to ask him for an update on Hodgkin lymphoma, which is an area of course we cover on Patient Power.  And of course always the biggest meeting is the ASH meeting, the American Society of Hematology, but six months before sometimes things happen here—any news here related to Hodgkin? 

Dr. Ansell:

Not really in Hodgkin lymphoma.  A lot of data that is about to come out but not available just yet.  The trial we're waiting for is the ABVD chemotherapy frontline comparisoned to AVD with the brentuximab vedotin (Adcetris) trial, and that is expected anytime.  So I think that's the next exciting news, but it wasn't at this meeting.  

Andrew Schorr:

Okay.  So you go to meetings all around the world throughout the year.  For people living with Hodgkin, sometimes you can cure it, sometimes it's resistant.  Where are we now in making progress in it?  How do you—what do you tell patients today? 

Dr. Ansell:

I think this is a time for patients to have a lot of optimism and a lot of hope, because I think there are more and more patients that are benefitting with less and less aggressive treatment.  And right now there are new drugs that are becoming mainstream, and just this year we've had another PD-1 antibody approved for Hodgkin lymphoma.  Previously we had nivolumab (Opdivo).  Now we have pembrolizumab (Keytruda), so two new drugs.  And right before that was brentuximab vedotin, or Adcetris, also a new drug.  All of those are now being used in various combinations in frontline, in second-line and in relapsed patients, so there are many new options available for patients. 

Andrew Schorr:

Okay.  Let's talk about some of those new approvals.  So you've had drugs that target the cancer cell. 

Dr. Ansell:

Correct.  

Andrew Schorr:

And now you have these other medicines that work on the immune system in combination to try to—is it take the brakes off the cancer or have the cancer be seen by the immune system? 

Dr. Ansell:

I think a little bit of both.  So one of the things that is pretty unique about Hodgkin lymphoma is that if you look at under a microscope only a small percentage, maybe 1 to 5 percent, of the cells are Reed-Sternberg cells, cancer cells, and the vast majority of what's in the lymph node are inflammatory normal cells.  So it's a rich environment with cells that are present, and the goal is obviously to get them to detect and then target and clear the cancer cells.  So that's really what PD-1 blockade seems to be doing. 

The malignant cell has the little protein that signals through PD-1 at a very high level on the surface, and lots of the T cells obviously are suppressed by this protein.  So blocking that interaction allows the T cells to, as it were, wake up, and see the trouble and target the malignant cell.  And it seems to be a very effective therapy in Hodgkin lymphoma, even more so than it is in other diseases. 

Andrew Schorr:

Wow.  And of course we've been hearing about it in other diseases.  And one other question for you, not all but a lot of the people who develop Hodgkin lymphoma are younger, and sometimes you're treated pretty aggressively, and the worry is might you develop another cancer later or some side effect later.  Where are we now in having therapies that can help people just go on with a healthy life, long term? 

Dr. Ansell:

I think there's two ways in which that's being actively tested and pursued.  One way is to say, okay, we have effective standard therapy, but do you need to give everybody as much treatment?  And there is pretty good evidence to say if you have a good response and a PET scan for example becomes negative after just two or three rounds of treatment, you can in some patients stop therapy, particularly if they have limited?stage disease, and not necessarily go on to more chemotherapy or radiation therapy and still get excellent results.  

Similarly, there have been data about patients getting ABVD treatment, two rounds of treatment and a PET scan, PET scan is negative—in other words things are well on track for a good outcome—and then taking out a drug like bleomycin, which has a lot of lung toxicity, and just continuing with the remaining part of the combination and still maintaining the excellent outcomes.  So that's one way of just taking away more treatment than you need if you're doing well. 

The second way now is to bring some of those new drugs we just spoke about and include them in frontline and in second?line combinations. And if those studies prove as effective as hoped, we may actually be able to dispense with some of the more kind of non-specific toxic treatments. 

Andrew Schorr:

Dr. Ansell, so, as I said, many of the people who are diagnosed with Hodgkin lymphoma, not, you know, one of the most common cancers, are hoping for a long, healthy life.  What do you want to say to them who may be watching about how they can get at some of this new science and hold—have that hope? 

Dr. Ansell:

Well, I think the exciting things with all of these drugs now being approved, they're actually available right with the oncologists that many patients are being treated by with that practice.  

Also I think what patients can consider is participating in clinical trials because although it's approved in second- and third-line, it's not approved in frontline or even in some of the second-line settings.  So there's an opportunity to be part of that by participating in a clinical trial.  So we always encourage people to really think about clinical trials, because it's cutting edge, the new and latest and greatest and something that potentially would benefit the patient. 

Andrew Schorr:

Okay.  Well, I want to thank you, Dr. Stephen Ansell, at Mayo for the work you've done over so many years to help people with Hodgkin lymphoma.  Thank you. 

This is what we do is connect with you leading experts, and I think it sounds to be a very hopeful time but an actionable time with more approved medicines and trials going on that you might want to check out.  On location in Chicago for Patient Power, I'm Andrew Schorr.  Remember, knowledge can be the best medicine of all.  

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 July 26, 2017