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Early response to first-line anti-PD-1 treatment in Hodgkin lymphoma: a PET-based analysis from the prospective, randomized phase II NIVAHL trial

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Purpose: A primary analysis of the ongoing NIVAHL trial demonstrated unexpectedly high interim complete response rates to nivolumab-based first-line treatment in early-stage unfavorable Hodgkin lymphoma. However, biomarkers such as metabolic tumor volume (MTV) or total lesion glycolysis (TLG) and th...

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Main Authors: Voltin, Conrad-Amadeus (Author) , Mettler, Jasmin (Author) , Heek, Lutz van (Author) , Goergen, Helen (Author) , Müller, Horst (Author) , Baues, Christian (Author) , Keller, Ulrich (Author) , Meißner, Julia (Author) , Trautmann-Grill, Karolin (Author) , Kerkhoff, Andrea (Author) , Fuchs, Michael (Author) , Sasse, Stephanie (Author) , Tresckow, Bastian von (Author) , Dietlein, Markus (Author) , Borchmann, Peter (Author) , Engert, Andreas (Author) , Kobe, Carsten (Author) , Bröckelmann, Paul J. (Author)
Format: Article (Journal)
Language:English
Published: 2021
In: Clinical cancer research
Year: 2021, Volume: 27, Issue: 2, Pages: 402-407
ISSN:1557-3265
DOI:10.1158/1078-0432.CCR-20-3303
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1158/1078-0432.CCR-20-3303
Verlag, lizenzpflichtig, Volltext: https://clincancerres.aacrjournals.org/content/27/2/402
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Author Notes:Conrad-Amadeus Voltin, Jasmin Mettler, Lutz van Heek, Helen Goergen, Horst Müller, Christian Baues, Ulrich Keller, Julia Meissner, Karolin Trautmann-Grill, Andrea Kerkhoff, Michael Fuchs, Stephanie Sasse, Bastian von Tresckow, Markus Dietlein, Peter Borchmann, Andreas Engert, Carsten Kobe, and Paul J. Bröckelmann
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Summary:Purpose: A primary analysis of the ongoing NIVAHL trial demonstrated unexpectedly high interim complete response rates to nivolumab-based first-line treatment in early-stage unfavorable Hodgkin lymphoma. However, biomarkers such as metabolic tumor volume (MTV) or total lesion glycolysis (TLG) and their change under treatment (ΔMTV and ΔTLG), measured on PET, might provide additional relevant information for response assessment in this setting. Hence, the current analysis aimed to investigate early response to checkpoint inhibitor therapy beyond conventional criteria. - Patients and Methods: NIVAHL is a prospective, randomized phase II trial that recruited between April 2017 and October 2018. Patients in arms A and B were assessed for early treatment response after two courses of doxorubicin, vinblastine, and dacarbazine with two concomitant nivolumab infusions per cycle (2 × N-AVD) and 4 × nivolumab, respectively. In the current analysis, we included all 59 individuals with PET images available to the central review panel for quantitative analysis before April 30, 2019. - Results: At interim restaging, we determined a mean ΔMTV and ΔTLG of −99.8% each in arm A after 2 × N-AVD, compared with −91.4% and −91.9%, respectively, for treatment group B undergoing 4 × nivolumab. This high decrease in MTV and TLG was observed regardless of the initial lymphoma burden. - Conclusions: Our study showed that nivolumab-based first-line treatment leads to rapid, near-complete reduction of tumor metabolism in early-stage unfavorable Hodgkin lymphoma. Thus, PET-derived biomarkers might allow reduction or even omission of chemotherapy and radiotherapy. Furthermore, MTV and TLG could be also used to optimize immune checkpoint-targeting treatments in other cancers.
Item Description:Published online first October 29, 2020
Gesehen am 10.08.2021
Physical Description:Online Resource
ISSN:1557-3265
DOI:10.1158/1078-0432.CCR-20-3303

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