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Dube ZF, Soremekun OS, Ntombela T, Alahmdi MI, Abo-Dya NE, Sidhom PA, Shawky AM, Shibl MF, Ibrahim MA, Soliman ME. Inherent efficacies of pyrazole-based derivatives for cancer therapy: the interface between experiment and in silico. Future Med Chem 2023; 15:1719-1738. [PMID: 37772542 DOI: 10.4155/fmc-2023-0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
There has been an increasing trend in the design of novel pyrazole derivatives for desired biological applications. For a cost-effective strategy, scientists have implemented various computational drug design tools to go hand in hand with experiments for the design and discovery of potentially effective pyrazole-based therapeutics. This review highlights the milestones of pyrazole-containing inhibitors and the use of molecular modeling techniques in conjunction with experimental studies to provide a view of the binding mechanism of these compounds. The review focuses on the established targets that play a key role in cancer therapy, including proteins involved in tubulin polymerization, carbonic anhydrase and tyrosine kinase. Overall, using both experimental and computational methods in drug design represents a promising approach to cancer therapy.
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Affiliation(s)
- Zanele F Dube
- Molecular Bio-Computational & Drug Design Laboratory, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, 4001, South Africa
| | - Opeyemi S Soremekun
- Molecular Bio-Computational & Drug Design Laboratory, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, 4001, South Africa
- Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, South Kensington, London, SW7 2BX, UK
| | - Thandokuhle Ntombela
- Catalysis & Peptide Research Unit, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, 4001, South Africa
| | - Mohammed Issa Alahmdi
- Department of Chemistry, Faculty of Science, University of Tabuk, Tabuk, 71491, Saudi Arabia
| | - Nader E Abo-Dya
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Tabuk, Tabuk, 71491, Saudi Arabia
- Department of Pharmaceutical Organic Chemistry, Faculty of Pharmacy, Zagazig University, Zagazig, 44519, Egypt
| | - Peter A Sidhom
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Tanta University, Tanta, 31527, Egypt
| | - Ahmed M Shawky
- Science & Technology Unit, Umm Al-Qura University, Makkah, 21955, Saudi Arabia
| | - Mohamed F Shibl
- Renewable Energy Program, Center for Sustainable Development, College of Arts & Sciences, Qatar University, Doha, 2713, Qatar
| | - Mahmoud Aa Ibrahim
- Molecular Bio-Computational & Drug Design Laboratory, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, 4001, South Africa
- Computational Chemistry Laboratory, Chemistry Department, Faculty of Science, Minia University, Minia, 61519, Egypt
| | - Mahmoud Es Soliman
- Molecular Bio-Computational & Drug Design Laboratory, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, 4001, South Africa
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2
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Pinel P, Guichaoua G, Najm M, Labouille S, Drizard N, Gaston-Mathé Y, Hoffmann B, Stoven V. Exploring isofunctional molecules: Design of a benchmark and evaluation of prediction performance. Mol Inform 2023; 42:e2200216. [PMID: 36633361 DOI: 10.1002/minf.202200216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/19/2022] [Accepted: 01/11/2023] [Indexed: 01/13/2023]
Abstract
Identification of novel chemotypes with biological activity similar to a known active molecule is an important challenge in drug discovery called 'scaffold hopping'. Small-, medium-, and large-step scaffold hopping efforts may lead to increasing degrees of chemical structure novelty with respect to the parent compound. In the present paper, we focus on the problem of large-step scaffold hopping. We assembled a high quality and well characterized dataset of scaffold hopping examples comprising pairs of active molecules and including a variety of protein targets. This dataset was used to build a benchmark corresponding to the setting of real-life applications: one active molecule is known, and the second active is searched among a set of decoys chosen in a way to avoid statistical bias. This allowed us to evaluate the performance of computational methods for solving large-step scaffold hopping problems. In particular, we assessed how difficult these problems are, particularly for classical 2D and 3D ligand-based methods. We also showed that a machine-learning chemogenomic algorithm outperforms classical methods and we provided some useful hints for future improvements.
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Affiliation(s)
- Philippe Pinel
- Center for Computational Biology, Mines Paris-PSL, PSL Research University, 75006, Paris, France.,Institut Curie, 75248, Paris, France.,INSERM U900, 75428, Paris, France.,Iktos SAS, 75017, Paris, France
| | - Gwenn Guichaoua
- Center for Computational Biology, Mines Paris-PSL, PSL Research University, 75006, Paris, France.,Institut Curie, 75248, Paris, France.,INSERM U900, 75428, Paris, France
| | - Matthieu Najm
- Center for Computational Biology, Mines Paris-PSL, PSL Research University, 75006, Paris, France.,Institut Curie, 75248, Paris, France.,INSERM U900, 75428, Paris, France
| | | | | | | | | | - Véronique Stoven
- Center for Computational Biology, Mines Paris-PSL, PSL Research University, 75006, Paris, France.,Institut Curie, 75248, Paris, France.,INSERM U900, 75428, Paris, France
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3
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Weil CR, Parsons MJ, Hutten RJ, Lew FH, Johnson SB, Gaffney DK, Tao R. Patterns of care and outcomes of early stage I-II Hodgkin lymphoma treated with or without radiation therapy. Leuk Lymphoma 2022; 63:2847-2857. [PMID: 35904407 DOI: 10.1080/10428194.2022.2105325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Omission of radiotherapy in the upfront management of early-stage classic Hodgkin lymphoma (cHL) has become more common with time. We report patterns of care and outcomes of stage I-II cHL treated with chemotherapy (CT) only versus CT and radiotherapy (combined modality therapy, CMT). From the National Cancer Database, we identified 28,327 early-stage cHL patients treated with CT (n = 15,798) or CMT (n = 12,529) from 2004 to 2018. CMT utilization declined over the period from 58% to 34%. With median follow-up of 6.2 years, the 5- and 10-year overall survival for CT versus CMT was 93.3% versus 96.9% (p < 0.001) and 88.7% versus 93.5% (p < 0.001), respectively. On multivariable analysis, uninsured (OR 0.75, p < 0.001) and Black patients (OR 0.86, p = 0.02) were less likely to receive CMT, and treatment with CT was predictive of death (OR 2.0, p < 0.001). This report highlights real-world outcomes in early-stage cHL, with worse survival with CT and notable disparities in CMT utilization.
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Affiliation(s)
- Christopher R Weil
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT, USA.,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Matthew J Parsons
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ryan J Hutten
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Felicia H Lew
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Skyler B Johnson
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - David K Gaffney
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Randa Tao
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT, USA
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4
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[The guidelines for diagnosis and treatment of Hodgkin lymphoma in China (2022)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:705-715. [PMID: 36709163 PMCID: PMC9613489 DOI: 10.3760/cma.j.issn.0253-2727.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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5
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Long-Term Outcomes of Patients With Early Stage Nonbulky Hodgkin Lymphoma Treated With Combined Modality Therapy in the Stanford V Trials (the G4 and G5 Studies). Int J Radiat Oncol Biol Phys 2020; 110:444-451. [PMID: 33385495 DOI: 10.1016/j.ijrobp.2020.12.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/24/2020] [Accepted: 12/22/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Combined modality therapy (CMT) is standard therapy for early-stage Hodgkin lymphoma (ESHL). We previously reported excellent outcomes with the abbreviated Stanford V regimen. Herein we report updated results with median follow-up >10 years on survival, therapy-related late effects, and impact of disease risk factors on patient outcomes. METHODS AND MATERIALS The G4 and G5 studies enrolled patients with stage I-IIA nonbulky ESHL. Patients received 8 weeks of Stanford V chemotherapy followed by 30 Gy modified involved-field radiation therapy (mIFRT) (G4) or Stanford V-C + 20 Gy mIFRT (G5). Patients were categorized as favorable or unfavorable risk per German Hodgkin Study Group (GHSG) criteria and outcomes between groups compared. RESULTS A total of 129 patients were enrolled (68 favorable and 61 unfavorable risk). In the G4 study (n = 87), at median follow-up of 19.7 years, 5-, 10-, and 15-year progression-free survival (PFS) and overall survival (OS) were 95.4%/97.7%, 91.8%/96.5%, and 91.8%/95.3%, respectively. In the G5 study (n = 42), at median follow-up of 13.5 years, the 5-, 10-, and 15-year PFS and OS were 92.9%/100%, 92.9%/100%, and 88.4%/91.9%, respectively. PFS (P = .86) and OS (P = .86) were not significantly different between studies. There were also no significant differences between studies in patients with favorable or unfavorable risk for PFS (F: P = .53; U: P = .96), OS (F: P = .99; U: P = .78), secondary malignancies (F: P = .74; U: P = 1.0), and cardiovascular complications (F: no cases; U: P = 1.0). CONCLUSIONS The G4 and G5 studies achieve high rates of durable remission; 20 versus 30 Gy mIFRT and cyclophosphamide substituted for mechlorethamine did not compromise nodal control, PFS, or OS in both favorable and unfavorable risk disease. These results support the efficacy of CMT in early-stage disease and lower-dose radiation therapy in patients with favorable and nonbulky unfavorable ESHL.
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Boilève A, Grignano E, Bouscary D, Fourquet A, Deau-Fischer B, Kirova Y. Relapsed, Refractory, or Advanced Hodgkin Lymphoma: A Single-Center Experience. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 21:e27-e31. [PMID: 32933880 DOI: 10.1016/j.clml.2020.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/17/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the treatment and outcomes of patients with relapsed, refractory, or advanced Hodgkin lymphoma treated with consolidation or salvage radiotherapy. PATIENTS AND METHODS We studied all patients diagnosed with this profile treated by radiotherapy in our center between 2006 and 2019. RESULTS A total of 33 patients who received external-beam radiotherapy for advanced (21%), relapsed (52%), or refractory (24%) Hodgkin lymphoma were studied. Median [interquartile range] age was 25 [22-38] years, with 11 women (33%). The follow-up after first-line treatment was 28 [10-53] months. Number of chemotherapy lines received before radiotherapy was 3 [1-4]. Fourteen patients (42%) had undergone autologous stem-cell transplantation before radiotherapy, and 2 patients were treated by radiotherapy alone. Nine patients (27%) were treated by involved-field radiotherapy, 17 (52%) by involved-site radiotherapy, 5 (17%) by involved-node radiotherapy, and 2 by other volumes. The acute toxicity profile was favorable, with grade 1 radiodermatitis (33%) or dysphagia (30%). Overall, 21 patients (64%) experienced prolonged complete response and 12 experienced relapse (36%) after radiotherapy. Median disease-free survival was 68.8 months. CONCLUSIONS External-beam radiotherapy should be considered an effective treatment modality for advanced, relapsed, or refractory Hodgkin lymphoma as part of a multimodal approach.
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Affiliation(s)
- Alice Boilève
- Département de radiothérapie, Institut Curie, Paris, France.
| | - Eric Grignano
- Département d'hématologie Clinique, Hôpital Cochin, Paris, France
| | - Didier Bouscary
- Département d'hématologie Clinique, Hôpital Cochin, Paris, France
| | - Alain Fourquet
- Département de radiothérapie, Institut Curie, Paris, France
| | | | - Youlia Kirova
- Département de radiothérapie, Institut Curie, Paris, France
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7
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Hoppe RT, Advani RH, Ai WZ, Ambinder RF, Armand P, Bello CM, Benitez CM, Bierman PJ, Boughan KM, Dabaja B, Gordon LI, Hernandez-Ilizaliturri FJ, Herrera AF, Hochberg EP, Huang J, Johnston PB, Kaminski MS, Kenkre VP, Khan N, Lynch RC, Maddocks K, McConathy J, McKinney M, Metzger M, Morgan D, Mulroney C, Rabinovitch R, Rosenspire KC, Seropian S, Tao R, Winter JN, Yahalom J, Burns JL, Ogba N. Hodgkin Lymphoma, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 18:755-781. [DOI: 10.6004/jnccn.2020.0026] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The NCCN Clinical Practice Guidelines in Oncology for Hodgkin Lymphoma (HL) provide recommendations for the management of adult patients with HL. The NCCN panel meets at least annually to review comments from reviewers within their institutions, examine relevant data, and reevaluate and update their recommendations. Current management of classic HL involves initial treatment with chemotherapy alone or combined modality therapy followed by restaging with PET/CT to assess treatment response. Overall, the introduction of less toxic and more effective regimens has significantly advanced HL cure rates. This portion of the NCCN Guidelines focuses on the management of classic HL.
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Affiliation(s)
| | | | - Weiyun Z. Ai
- 2UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | | | - Kirsten M. Boughan
- 7Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Leo I. Gordon
- 9Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Jiayi Huang
- 13Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | - Ryan C. Lynch
- 18Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - Kami Maddocks
- 19The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - Monika Metzger
- 22St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | | | | | - Randa Tao
- 28Huntsman Cancer Institute at the University of Utah
| | - Jane N. Winter
- 9Robert H. Lurie Comprehensive Cancer Center of Northwestern University
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8
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Weil CR, Qian Y, Von Eyben R, Daadi SE, Corbelli KS, Rosenberg SA, Advani RH, Hoppe RT. Long-term outcomes of patients with unfavorable stage I-II classic Hodgkin lymphoma treated with Stanford V chemotherapy and limited field irradiation. Leuk Lymphoma 2020; 61:2428-2434. [PMID: 32476541 DOI: 10.1080/10428194.2020.1768385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Management of stage I-II unfavorable risk Hodgkin lymphoma (HL) strives to reduce toxicity while maintaining tumor control. Compared to ABVD or BEACOPP, Stanford V chemotherapy contains less doxorubicin and bleomycin. We report long-term outcomes of patients with stage I-II classic HL with European risk factors treated with Stanford V combined modality therapy (CMT). From our institutional cancer registry, we identified 168 patients with ≥1 European risk factor treated with 8-12 weeks of Stanford V CMT and consolidative radiotherapy between 1990 and 2016. Outcomes were analyzed after classification by EORTC and GHSG unfavorable criteria. With median follow-up of 8.4 years, 10-year overall survival and progression-free survival for the entire cohort were 95% and 88%, respectively. Thirteen of 18 relapses were salvaged successfully. There were no cases of MDS or AML after primary therapy. Long-term outcomes of stage I-II unfavorable risk HL treated with Stanford V CMT are comparable to ABVD or BEACOPP regimens.
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Affiliation(s)
- Christopher R Weil
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Yushen Qian
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Rie Von Eyben
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Sarah E Daadi
- Department of Medicine, Division of Medical Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Karen S Corbelli
- Department of Medicine, Division of Medical Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Saul A Rosenberg
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA.,Department of Medicine, Division of Medical Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ranjana H Advani
- Department of Medicine, Division of Medical Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Richard T Hoppe
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
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9
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Lynch RC, Sundaram V, Desai M, Henry S, Wood D, Daadi S, Hoppe RT, Advani R. Utility of Routine Surveillance Laboratory Testing in Detecting Relapse in Patients With Classic Hodgkin Lymphoma in First Remission: Results From a Large Single-Institution Study. JCO Oncol Pract 2020; 16:e902-e911. [PMID: 32369413 DOI: 10.1200/jop.19.00733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Classic Hodgkin lymphoma is highly curable with contemporary therapy. Although the limited role of surveillance imaging to detect early relapse for patients in complete remission at the end of therapy is well established, there is a paucity of data regarding role of laboratory testing in this setting. METHODS Patients with newly diagnosed classic Hodgkin lymphoma uniformly treated with the Stanford V regimen from 1998-2014 and in complete remission for at least 3 months were identified in a single-center institutional database. Laboratory tests categorized by Common Terminology Criteria for Adverse Events v4.03 as grade 2 or higher were considered abnormal. Primary analysis included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of surveillance laboratory tests for predicting relapse in the first 3 years after end of treatment. RESULTS Among 235 eligible patients, 24 (10.2%) patients ultimately relapsed. In the first 3 years after end of therapy, the mean number of surveillance blood draws per patient was 7.1, (range, 1-13). These 1,661 surveillance blood draws included 4,684 individual laboratory tests, comprising 1,609 CBCs, 1,578 metabolic panels, and 1,497 erythrocyte sedimentation rates. None of the biopsies confirming relapses were prompted by any abnormal laboratory finding. The sensitivity of any surveillance laboratory test for detecting relapse within 3 years of end of treatment was 72.7% (95% CI, 49.8% to 89.3%), specificity 22.6% (95% CI, 17.2% to 28.9%), yielding a PPV of 8.9% (95% CI, 7.0% to 11.3%) and NPV of 88.9% (95% CI, 79% to 94%). CONCLUSION Our study found limited clinically meaningful utility for routine surveillance laboratory testing in detecting relapse in patients with complete remission at end of treatment. Our results warrant consideration of modifications to current practice guidelines.
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Affiliation(s)
- Ryan C Lynch
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA.,Fred Hutchinson Cancer Research Center, Seattle, WA.,Division of Oncology, Department of Medicine, Stanford University, Stanford, CA
| | - Vandana Sundaram
- Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA
| | - Manisha Desai
- Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA
| | - Solomon Henry
- Stanford University School of Medicine, Stanford, CA
| | - Douglas Wood
- Stanford University School of Medicine, Stanford, CA
| | | | - Richard T Hoppe
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Ranjana Advani
- Department of Medicine, Stanford University, Stanford, CA
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10
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Myint ZW, Shrestha R, Siddiqui S, Slone S, Huang B, Ramlal R, Monohan GP, Hildebrandt GC, Saeed H. Ten-year survival outcomes for patients with early stage classical Hodgkin lymphoma: An analysis from Kentucky Cancer Registry. Hematol Oncol Stem Cell Ther 2019; 13:17-22. [PMID: 31629724 DOI: 10.1016/j.hemonc.2019.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 08/30/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE/BACKGROUND Early stage classical Hodgkin lymphoma (cHL) has an excellent outcome. Recent studies focus on decreasing toxicity related to the addition of radiation along with chemotherapy. Real-life reporting of the addition of radiation to chemotherapy is lacking. This study investigates the outcomes obtained from a statewide cancer registry for early stage cHL patients treated with chemotherapy alone (CT) versus patients treated with the combined modality of chemotherapy and radiation (CMT). METHODS A retrospective study of cHL patients diagnosed and treated was identified using a statewide cancer registry from 2005 to 2014. Patients with early stage disease (I, II) were then grouped on the basis of the presence of B symptoms into favorable and unfavorable groups. Baseline characteristics (age, gender, extranodal involvement, and histology) as well as overall survival were compared for both groups depending on whether they received CT or CMT as first line therapy for their cHL. RESULTS A total of 961 patients were identified; of those, 127 were excluded as they received only radiation or another form of treatment. Of the remaining patients, 293 were categorized as early stage favorable cHL (Group 1) and 130 adults were in the unfavorable cHL (Group 2). There were 335 patients with advanced stage cHL (Group 3) and 76 patients in an unknown stage. The 10-year overall survival for Group 1 was 81.3% versus 76.3% for Group 2 and 52.7% for Group 3. For Group 1, 10-year overall survival was 86.7% with CMT versus 75.1% for those receiving CT only (p = .004). For Group 2, there was no difference in 10-year overall survival between the CMT group (80.0%) and CT (72.5%) (p = .73). CONCLUSION While radiation therapy might increase long-term toxicity in cHL, in our large data cohort, radiotherapy consolidation as part of the initial therapy for early stage disease provides superior survival at 10 years, especially in favorable risk cHL.
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Affiliation(s)
- Zin W Myint
- Department of Internal Medicine, Division of Medical Oncology, University of Kentucky, USA
| | - Runa Shrestha
- Department of Internal Medicine, Division of Hematology/BMT, USA
| | | | - Stacey Slone
- Biostatistics and Bioinformatics Shared Resources Facility, USA
| | - Bin Huang
- Department of Internal Medicine, Division of Hematology/BMT, USA; Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Reshma Ramlal
- Department of Internal Medicine, Division of Hematology/BMT, USA
| | | | | | - Hayder Saeed
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
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11
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Shindiapina P, Alinari L. Pembrolizumab and its role in relapsed/refractory classical Hodgkin's lymphoma: evidence to date and clinical utility. Ther Adv Hematol 2018; 9:89-105. [PMID: 29623180 PMCID: PMC5881987 DOI: 10.1177/2040620718761777] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/06/2018] [Indexed: 12/28/2022] Open
Abstract
Immune evasion is a critical mechanism of malignant cell survival, and relies in part on molecular signaling through the programmed cell death 1 (PD-1)/PD-1 ligand (PD-L1) axis that contributes to T cell exhaustion. Immune modulatory therapy with monoclonal antibodies against PD-1 designed to enhance antitumor immune response have shown promise in the treatment of advanced solid tumors and hematologic malignancies. Classical Hodgkin's lymphoma (cHL), a unique B cell malignancy characterized by an extensive but ineffective immune cell infiltrate surrounding a small number of tumor cells, has shown significant response to anti-PD-1 directed therapy. The anti-PD-1 monoclonal antibodies nivolumab and pembrolizumab have shown similarly remarkable activity in relapsed/refractory cHL and have been approved by the Food and Drug Administration for treatment of this disease. In this article we review the rationale of targeting the PD-1/PD-L1 axis in cHL and the pharmacology of pembrolizumab, and summarize the data on activity and safety profile of this agent in the treatment of relapsed/refractory cHL. We also discuss the potential benefits and pitfalls of using PD-1 blockade in the setting of allogeneic stem-cell transplantation, and summarize ongoing prospective trials of single-agent pembrolizumab and combination strategies as well as future directions.
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Affiliation(s)
- Polina Shindiapina
- Department of Internal Medicine, Division of Hematology, Arthur G James Comprehensive Cancer Center, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lapo Alinari
- Division of Hematology, Department of Internal Medicine, Ohio State University Wexner Medical Center, 410 West 12th Avenue, 481A Wiseman Hall, Columbus, Ohio, 43210, USA
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12
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Abstract
This topic addresses the treatment of newly diagnosed patients with favorable prognosis stage I and II Hodgkin lymphoma. In most cases, combined modality therapy (chemotherapy followed by involved site radiation therapy) constitutes the current standard of care. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. By combining the most recent medical literature and expert opinion, this revised guideline can aid clinicians in the appropriate use of combined modality therapy for favorable prognosis stage I and II Hodgkin lymphoma. Increasing information about the late effects of treatment has led to attempts to decrease toxicity by using less chemotherapy (decreased duration and/or intensity or different agents) and less radiation therapy (reduced volume and/or dose) while maintaining excellent efficacy.
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13
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Kaste SC, Snyder SE, Metzger ML, Sandlund JT, Howard SC, Krasin M, Shulkin BL. Comparison of 11C-Methionine and 18F-FDG PET/CT for Staging and Follow-up of Pediatric Lymphoma. J Nucl Med 2016; 58:419-424. [PMID: 27609791 DOI: 10.2967/jnumed.116.178640] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/22/2016] [Indexed: 02/03/2023] Open
Abstract
Methionine transport across plasma membranes occurs via the large amino acid transporter, which is overexpressed in malignant cells, leading to tracer accumulation within tumors. We investigated the uptake of 11C-methionine (11C-MET) in children and young adults with Hodgkin lymphoma (HL) or non-Hodgkin lymphoma (NHL) and compared the biodistribution of 11C-MET PET/CT with that of 18F-FDG PET/CT. Methods: Conducted under an investigational new drug authorization, we prospectively enrolled patients with newly diagnosed HL (n = 19) and NHL (n = 2) onto the Institutional Review Board-approved investigation of 11C-MET PET/CT. After a minimum 4-h fast, patients received 740 MBq/1.7 m2 (maximum, 740 MBq [20 mCi/1.7 m2; maximum, 20 mCi]) of 11C-methionine intravenously. PET/CT was performed 5 min after injection from the vertex to thighs at 3 min per bed position. In a separate session, patients received 5.5 MBq/kg (maximum, 485 MBq [0.15 mCi/kg; maximum, 12 mCi]) of 18F-FDG with imaging initiated approximately 1 h after radiopharmaceutical administration. All studies were reviewed by consensus of 2 senior imaging specialists. The presence of metabolic activity on baseline studies was compared among 17 nodal groups. Results: Eighteen patients (11 male; median age, 15.2 y; age range, 9.5-22.6 y) comprised the study cohort. All had paired 11C-MET PET/CT and 18F-FDG PET/CT studies at diagnosis. At baseline, 3 nodal groups demonstrating discordant metabolic activity by both 18F-FDG PET/CT and 11C-MET PET/CT were Waldeyer's ring, paraaortic region, and the liver. All others were found to have concordant metabolic activity. Normal intense 11C-MET uptake in the pancreas and liver reduced sensitivity for disease detection in these regions. At follow-up, 14 of 15 study pairs had concordant results. Conclusion:11C-MET uptake is elevated in most regions involved with lymphoma at diagnosis and follow-up. Its utility in the abdomen is limited by uptake in normal structures.
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Affiliation(s)
- Sue C Kaste
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee .,Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Radiology, University of Tennessee, School of Health Sciences, Memphis, Tennessee
| | - Scott E Snyder
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Monika L Metzger
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Pediatrics, University of Tennessee, School of Health Sciences, Memphis, Tennessee
| | - John T Sandlund
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Pediatrics, University of Tennessee, School of Health Sciences, Memphis, Tennessee
| | - Scott C Howard
- School of Health Studies, University of Memphis, Memphis, Tennessee; and
| | - Matthew Krasin
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Radiology, University of Tennessee, School of Health Sciences, Memphis, Tennessee
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ACR Appropriateness Criteria® Hodgkin Lymphoma—Unfavorable Clinical Stage I and II. Am J Clin Oncol 2016; 39:384-95. [DOI: 10.1097/coc.0000000000000294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hodgkin Lymphoma: the Changing Role of Radiation Therapy in Early-Stage Disease—the Role of Functional Imaging. Curr Treat Options Oncol 2016; 16:45. [PMID: 26187795 DOI: 10.1007/s11864-015-0360-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Early-stage classical Hodgkin lymphoma (CHL) is a highly curable malignancy. Historically, extended-field radiotherapy (EFRT) alone showed excellent cure rates, but the risk of radiotherapy (RT)-associated toxicities led to combined modality therapy (CMT) replacing RT alone. RT has subsequently evolved further with significant reductions of dose and field size, and is currently restricted to involved sites only (ISRT). Contemporary CMT yields cure rates in excess of 85%, and most studies do not have adequate follow-up required to evaluate the risk reduction in late effects. In an effort to avoid RT altogether, response-adapted treatment approaches utilizing results of interim [(18)F]fluorodeoxyglucose (FDG) positron emission tomography with fused computed tomography (PET/CT) imaging have been studied. Results from two studies in favorable-risk (UK RAPID and EORTC H10F) and one in unfavorable-risk patients (EORTC H10U) suggest that omission of RT in patients with a negative interim PET/CT response (Deauville score ≤2) yields slightly inferior progression-free survival (PFS) compared to conventional CMT, but with no difference in overall survival (OS) albeit with short-term follow-up. In order to extrapolate results to daily practice, it is critical to understand the selection of patients entered on trials since definitions of favorable and unfavorable disease vary between study groups. Currently, CMT continues to be the standard of care for the vast majority of patients with early-stage CHL and RT is an integral part of therapy in patients with bulky disease. However, for selected patients with favorable characteristics, emerging data suggest that a chemotherapy-alone approach is reasonable.
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16
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Roemer MGM, Advani RH, Ligon AH, Natkunam Y, Redd RA, Homer H, Connelly CF, Sun HH, Daadi SE, Freeman GJ, Armand P, Chapuy B, de Jong D, Hoppe RT, Neuberg DS, Rodig SJ, Shipp MA. PD-L1 and PD-L2 Genetic Alterations Define Classical Hodgkin Lymphoma and Predict Outcome. J Clin Oncol 2016; 34:2690-7. [PMID: 27069084 DOI: 10.1200/jco.2016.66.4482] [Citation(s) in RCA: 540] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Classical Hodgkin lymphomas (cHLs) include small numbers of malignant Reed-Sternberg cells within an extensive but ineffective inflammatory/immune cell infiltrate. In cHL, chromosome 9p24.1/PD-L1/PD-L2 alterations increase the abundance of the PD-1 ligands, PD-L1 and PD-L2, and their further induction through Janus kinase 2-signal transducers and activators of transcription signaling. The unique composition of cHL limits its analysis with high-throughput genomic assays. Therefore, the precise incidence, nature, and prognostic significance of PD-L1/PD-L2 alterations in cHL remain undefined. METHODS We used a fluorescent in situ hybridization assay to evaluate CD274/PD-L1 and PDCD1LG2/PD-L2 alterations in 108 biopsy specimens from patients with newly diagnosed cHL who were treated with the Stanford V regimen and had long-term follow-up. In each case, the frequency and magnitude of 9p24.1 alterations-polysomy, copy gain, and amplification-were determined, and the expression of PD-L1 and PD-L2 was evaluated by immunohistochemistry. We also assessed the association of 9p24.1 alterations with clinical parameters, which included stage (early stage I/II favorable risk, early stage unfavorable risk, advanced stage [AS] III/IV) and progression-free survival (PFS). RESULTS Ninety-seven percent of all evaluated cHLs had concordant alterations of the PD-L1 and PD-L2 loci (polysomy, 5% [five of 108]; copy gain, 56% [61 of 108]; amplification, 36% [39 of 108]). There was an association between PD-L1 protein expression and relative genetic alterations in this series. PFS was significantly shorter for patients with 9p24.1 amplification, and the incidence of 9p24.1 amplification was increased in patients with AS cHL. CONCLUSION PD-L1/PD-L2 alterations are a defining feature of cHL. Amplification of 9p24.1 is more common in patients with AS disease and associated with shorter PFS in this series. Further analyses of 9p24.1 alterations in patients treated with standard cHL induction regimens or checkpoint blockade are warranted.
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Affiliation(s)
- Margaretha G M Roemer
- Margaretha G.M. Roemer, Robert A. Redd, Heather Homer, Courtney F. Connelly, Gordon J. Freeman, Philippe Armand, Bjoern Chapuy, Donna S. Neuberg, and Margaret A. Shipp, Dana-Farber Cancer Institute; Azra H. Ligon, Heather H. Sun, and Scott J. Rodig, Brigham and Women's Hospital, Boston, MA; Margaretha G.M. Roemer and Daphne de Jong, VU University Medical Center, Amsterdam, the Netherlands; and Ranjana H. Advani, Yasodha Natkunam, Sarah E. Daadi, and Richard T. Hoppe, Stanford University Medical Center, Stanford, CA
| | - Ranjana H Advani
- Margaretha G.M. Roemer, Robert A. Redd, Heather Homer, Courtney F. Connelly, Gordon J. Freeman, Philippe Armand, Bjoern Chapuy, Donna S. Neuberg, and Margaret A. Shipp, Dana-Farber Cancer Institute; Azra H. Ligon, Heather H. Sun, and Scott J. Rodig, Brigham and Women's Hospital, Boston, MA; Margaretha G.M. Roemer and Daphne de Jong, VU University Medical Center, Amsterdam, the Netherlands; and Ranjana H. Advani, Yasodha Natkunam, Sarah E. Daadi, and Richard T. Hoppe, Stanford University Medical Center, Stanford, CA
| | - Azra H Ligon
- Margaretha G.M. Roemer, Robert A. Redd, Heather Homer, Courtney F. Connelly, Gordon J. Freeman, Philippe Armand, Bjoern Chapuy, Donna S. Neuberg, and Margaret A. Shipp, Dana-Farber Cancer Institute; Azra H. Ligon, Heather H. Sun, and Scott J. Rodig, Brigham and Women's Hospital, Boston, MA; Margaretha G.M. Roemer and Daphne de Jong, VU University Medical Center, Amsterdam, the Netherlands; and Ranjana H. Advani, Yasodha Natkunam, Sarah E. Daadi, and Richard T. Hoppe, Stanford University Medical Center, Stanford, CA
| | - Yasodha Natkunam
- Margaretha G.M. Roemer, Robert A. Redd, Heather Homer, Courtney F. Connelly, Gordon J. Freeman, Philippe Armand, Bjoern Chapuy, Donna S. Neuberg, and Margaret A. Shipp, Dana-Farber Cancer Institute; Azra H. Ligon, Heather H. Sun, and Scott J. Rodig, Brigham and Women's Hospital, Boston, MA; Margaretha G.M. Roemer and Daphne de Jong, VU University Medical Center, Amsterdam, the Netherlands; and Ranjana H. Advani, Yasodha Natkunam, Sarah E. Daadi, and Richard T. Hoppe, Stanford University Medical Center, Stanford, CA
| | - Robert A Redd
- Margaretha G.M. Roemer, Robert A. Redd, Heather Homer, Courtney F. Connelly, Gordon J. Freeman, Philippe Armand, Bjoern Chapuy, Donna S. Neuberg, and Margaret A. Shipp, Dana-Farber Cancer Institute; Azra H. Ligon, Heather H. Sun, and Scott J. Rodig, Brigham and Women's Hospital, Boston, MA; Margaretha G.M. Roemer and Daphne de Jong, VU University Medical Center, Amsterdam, the Netherlands; and Ranjana H. Advani, Yasodha Natkunam, Sarah E. Daadi, and Richard T. Hoppe, Stanford University Medical Center, Stanford, CA
| | - Heather Homer
- Margaretha G.M. Roemer, Robert A. Redd, Heather Homer, Courtney F. Connelly, Gordon J. Freeman, Philippe Armand, Bjoern Chapuy, Donna S. Neuberg, and Margaret A. Shipp, Dana-Farber Cancer Institute; Azra H. Ligon, Heather H. Sun, and Scott J. Rodig, Brigham and Women's Hospital, Boston, MA; Margaretha G.M. Roemer and Daphne de Jong, VU University Medical Center, Amsterdam, the Netherlands; and Ranjana H. Advani, Yasodha Natkunam, Sarah E. Daadi, and Richard T. Hoppe, Stanford University Medical Center, Stanford, CA
| | - Courtney F Connelly
- Margaretha G.M. Roemer, Robert A. Redd, Heather Homer, Courtney F. Connelly, Gordon J. Freeman, Philippe Armand, Bjoern Chapuy, Donna S. Neuberg, and Margaret A. Shipp, Dana-Farber Cancer Institute; Azra H. Ligon, Heather H. Sun, and Scott J. Rodig, Brigham and Women's Hospital, Boston, MA; Margaretha G.M. Roemer and Daphne de Jong, VU University Medical Center, Amsterdam, the Netherlands; and Ranjana H. Advani, Yasodha Natkunam, Sarah E. Daadi, and Richard T. Hoppe, Stanford University Medical Center, Stanford, CA
| | - Heather H Sun
- Margaretha G.M. Roemer, Robert A. Redd, Heather Homer, Courtney F. Connelly, Gordon J. Freeman, Philippe Armand, Bjoern Chapuy, Donna S. Neuberg, and Margaret A. Shipp, Dana-Farber Cancer Institute; Azra H. Ligon, Heather H. Sun, and Scott J. Rodig, Brigham and Women's Hospital, Boston, MA; Margaretha G.M. Roemer and Daphne de Jong, VU University Medical Center, Amsterdam, the Netherlands; and Ranjana H. Advani, Yasodha Natkunam, Sarah E. Daadi, and Richard T. Hoppe, Stanford University Medical Center, Stanford, CA
| | - Sarah E Daadi
- Margaretha G.M. Roemer, Robert A. Redd, Heather Homer, Courtney F. Connelly, Gordon J. Freeman, Philippe Armand, Bjoern Chapuy, Donna S. Neuberg, and Margaret A. Shipp, Dana-Farber Cancer Institute; Azra H. Ligon, Heather H. Sun, and Scott J. Rodig, Brigham and Women's Hospital, Boston, MA; Margaretha G.M. Roemer and Daphne de Jong, VU University Medical Center, Amsterdam, the Netherlands; and Ranjana H. Advani, Yasodha Natkunam, Sarah E. Daadi, and Richard T. Hoppe, Stanford University Medical Center, Stanford, CA
| | - Gordon J Freeman
- Margaretha G.M. Roemer, Robert A. Redd, Heather Homer, Courtney F. Connelly, Gordon J. Freeman, Philippe Armand, Bjoern Chapuy, Donna S. Neuberg, and Margaret A. Shipp, Dana-Farber Cancer Institute; Azra H. Ligon, Heather H. Sun, and Scott J. Rodig, Brigham and Women's Hospital, Boston, MA; Margaretha G.M. Roemer and Daphne de Jong, VU University Medical Center, Amsterdam, the Netherlands; and Ranjana H. Advani, Yasodha Natkunam, Sarah E. Daadi, and Richard T. Hoppe, Stanford University Medical Center, Stanford, CA
| | - Philippe Armand
- Margaretha G.M. Roemer, Robert A. Redd, Heather Homer, Courtney F. Connelly, Gordon J. Freeman, Philippe Armand, Bjoern Chapuy, Donna S. Neuberg, and Margaret A. Shipp, Dana-Farber Cancer Institute; Azra H. Ligon, Heather H. Sun, and Scott J. Rodig, Brigham and Women's Hospital, Boston, MA; Margaretha G.M. Roemer and Daphne de Jong, VU University Medical Center, Amsterdam, the Netherlands; and Ranjana H. Advani, Yasodha Natkunam, Sarah E. Daadi, and Richard T. Hoppe, Stanford University Medical Center, Stanford, CA
| | - Bjoern Chapuy
- Margaretha G.M. Roemer, Robert A. Redd, Heather Homer, Courtney F. Connelly, Gordon J. Freeman, Philippe Armand, Bjoern Chapuy, Donna S. Neuberg, and Margaret A. Shipp, Dana-Farber Cancer Institute; Azra H. Ligon, Heather H. Sun, and Scott J. Rodig, Brigham and Women's Hospital, Boston, MA; Margaretha G.M. Roemer and Daphne de Jong, VU University Medical Center, Amsterdam, the Netherlands; and Ranjana H. Advani, Yasodha Natkunam, Sarah E. Daadi, and Richard T. Hoppe, Stanford University Medical Center, Stanford, CA
| | - Daphne de Jong
- Margaretha G.M. Roemer, Robert A. Redd, Heather Homer, Courtney F. Connelly, Gordon J. Freeman, Philippe Armand, Bjoern Chapuy, Donna S. Neuberg, and Margaret A. Shipp, Dana-Farber Cancer Institute; Azra H. Ligon, Heather H. Sun, and Scott J. Rodig, Brigham and Women's Hospital, Boston, MA; Margaretha G.M. Roemer and Daphne de Jong, VU University Medical Center, Amsterdam, the Netherlands; and Ranjana H. Advani, Yasodha Natkunam, Sarah E. Daadi, and Richard T. Hoppe, Stanford University Medical Center, Stanford, CA
| | - Richard T Hoppe
- Margaretha G.M. Roemer, Robert A. Redd, Heather Homer, Courtney F. Connelly, Gordon J. Freeman, Philippe Armand, Bjoern Chapuy, Donna S. Neuberg, and Margaret A. Shipp, Dana-Farber Cancer Institute; Azra H. Ligon, Heather H. Sun, and Scott J. Rodig, Brigham and Women's Hospital, Boston, MA; Margaretha G.M. Roemer and Daphne de Jong, VU University Medical Center, Amsterdam, the Netherlands; and Ranjana H. Advani, Yasodha Natkunam, Sarah E. Daadi, and Richard T. Hoppe, Stanford University Medical Center, Stanford, CA
| | - Donna S Neuberg
- Margaretha G.M. Roemer, Robert A. Redd, Heather Homer, Courtney F. Connelly, Gordon J. Freeman, Philippe Armand, Bjoern Chapuy, Donna S. Neuberg, and Margaret A. Shipp, Dana-Farber Cancer Institute; Azra H. Ligon, Heather H. Sun, and Scott J. Rodig, Brigham and Women's Hospital, Boston, MA; Margaretha G.M. Roemer and Daphne de Jong, VU University Medical Center, Amsterdam, the Netherlands; and Ranjana H. Advani, Yasodha Natkunam, Sarah E. Daadi, and Richard T. Hoppe, Stanford University Medical Center, Stanford, CA
| | - Scott J Rodig
- Margaretha G.M. Roemer, Robert A. Redd, Heather Homer, Courtney F. Connelly, Gordon J. Freeman, Philippe Armand, Bjoern Chapuy, Donna S. Neuberg, and Margaret A. Shipp, Dana-Farber Cancer Institute; Azra H. Ligon, Heather H. Sun, and Scott J. Rodig, Brigham and Women's Hospital, Boston, MA; Margaretha G.M. Roemer and Daphne de Jong, VU University Medical Center, Amsterdam, the Netherlands; and Ranjana H. Advani, Yasodha Natkunam, Sarah E. Daadi, and Richard T. Hoppe, Stanford University Medical Center, Stanford, CA
| | - Margaret A Shipp
- Margaretha G.M. Roemer, Robert A. Redd, Heather Homer, Courtney F. Connelly, Gordon J. Freeman, Philippe Armand, Bjoern Chapuy, Donna S. Neuberg, and Margaret A. Shipp, Dana-Farber Cancer Institute; Azra H. Ligon, Heather H. Sun, and Scott J. Rodig, Brigham and Women's Hospital, Boston, MA; Margaretha G.M. Roemer and Daphne de Jong, VU University Medical Center, Amsterdam, the Netherlands; and Ranjana H. Advani, Yasodha Natkunam, Sarah E. Daadi, and Richard T. Hoppe, Stanford University Medical Center, Stanford, CA.
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17
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Ozdemir N, Dogan M, Sendur MAN, Yazici O, Abali H, Yazilitas D, Akinci MB, Aksoy S, Zengin N. Efficacy and safety of first line vincristine with doxorubicin, bleomycin and dacarbazine (ABOD) for Hodgkin's lymphoma: a single institute experience. Asian Pac J Cancer Prev 2015; 15:8715-8. [PMID: 25374196 DOI: 10.7314/apjcp.2014.15.20.8715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND ABVD (doxorubicin, bleomycin, vinblastine (Vb) and dacarbazine) is the standard regimen in Hodgkin's lymphoma (HL).Vincristine (O) is a mitotic spindle agent like Vb. We aimed to evaluate the efficacy and safety of O as a part of ABOD in HL. MATERIALS AND METHODS Patients who had ABOD were enrolled. Stage I-II HL were evaluated for unfavorable risk factors according to NCCN. National Cancer Institute Common Toxicity Criteria was used for toxicity. RESULTS Seventy-nine HL patients in our center between 2003 and 2007 were evaluated retrospectively. Median follow-up was 54 months. Most of the patients were male in their third decade. Median ABOD cycles were 6 (2-8). Primary refractory disease rate was 17.7% whereas it was 5.1% for early relapse and 5.1% for late relapse disease. Response rates were as 82.3% for complete response, 11.4% for partial response, 5.1% for stable disease and 1.3% for progressive disease. Half of relapsed patients had autologous stem cell transplantation. Estimated 5-year failure-free survival was 71% and significantly longer in early stage patients without risk factors, bulky disease or radiotherapy (RT) (p=0.05, p<0.0001, p=0.02; respectively). Estimated 5-year overall survival was 74% and significantly longer in those who had no RT (p=0.001). Dose modification rate was 5.1% and chemotherapy delay rate was 19%. There were no toxicity- related deaths. CONCLUSIONS ABOD seems to be effective with managable toxicity in HL, even in those with poor prognostic factors.
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Affiliation(s)
- Nuriye Ozdemir
- Department of Medical Oncology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey E-mail :
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18
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Hoppe RT, Advani RH, Ai WZ, Ambinder RF, Aoun P, Bello CM, Benitez CM, Bierman PJ, Blum KA, Chen R, Dabaja B, Forero A, Gordon LI, Hernandez-Ilizaliturri FJ, Hochberg EP, Huang J, Johnston PB, Khan N, Maloney DG, Mauch PM, Metzger M, Moore JO, Morgan D, Moskowitz CH, Mulroney C, Poppe M, Rabinovitch R, Seropian S, Tsien C, Winter JN, Yahalom J, Burns JL, Sundar H. Hodgkin lymphoma, version 2.2015. J Natl Compr Canc Netw 2015; 13:554-86. [PMID: 25964641 PMCID: PMC4898052 DOI: 10.6004/jnccn.2015.0075] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hodgkin lymphoma (HL) is an uncommon malignancy involving lymph nodes and the lymphatic system. Classical Hodgkin lymphoma (CHL) and nodular lymphocyte-predominant Hodgkin lymphoma are the 2 main types of HL. CHL accounts for most HL diagnosed in the Western countries. Chemotherapy or combined modality therapy, followed by restaging with PET/CT to assess treatment response using the Deauville criteria (5-point scale), is the standard initial treatment for patients with newly diagnosed CHL. Brentuximab vedotin, a CD30-directed antibody-drug conjugate, has produced encouraging results in the treatment of relapsed or refractory disease. The potential long-term effects of treatment remain an important consideration, and long-term follow-up is essential after completion of treatment.
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19
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Meyer RM, Hoppe RT. Point/counterpoint: early-stage Hodgkin lymphoma and the role of radiation therapy. Blood 2012; 120:4488-95. [PMID: 22821764 PMCID: PMC3512228 DOI: 10.1182/blood-2012-05-423236] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 06/28/2012] [Indexed: 11/20/2022] Open
Abstract
The results of recent clinical trials for the management of limited-stage Hodgkin lymphoma have led to considerable debate, especially regarding the role of radiation therapy. This review highlights those recent trials and provides perspectives regarding their interpretation from a radiation oncologist and a hematologist. The trial protocol is available at http://www.nejm.org/doi/suppl/10.1056/NEJMoa1111961/suppl_file/nejmoa1111961_protocol.pdf.
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Affiliation(s)
- Ralph M Meyer
- National Cancer Institute of Canada (NCIC) Clinical Trials Group, Queen's University, Kingston, Ontario, Canada
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20
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Maeda LS, Lee M, Advani RH. Current concepts and controversies in the management of early stage Hodgkin lymphoma. Leuk Lymphoma 2011; 52:962-71. [PMID: 21463118 PMCID: PMC4570567 DOI: 10.3109/10428194.2011.557455] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Over the past three decades, due to the recognition of late effects related to high-dose extended field radiotherapy and heavy alkylator chemotherapy, combined modality therapy with abbreviated chemotherapy and limited field radiotherapy has emerged as the standard of care for early stage Hodgkin lymphoma, with cure rates in excess of 80%. Currently, however, controversy remains over identifying the most appropriate criteria to risk-stratify patients with early stage disease, so that those with a favorable prognosis receive limited treatment without compromising cure rates and those with unfavorable risk receive more intensified therapy. The optimal risk stratification system remains unclear, with variable definitions of favorable and unfavorable disease used by research groups in North America and Europe. Thus, comparison of clinical trial results has been challenging, and additional controversies persist regarding optimal chemotherapy regimens, duration of therapy, and the role of radiotherapy. Investigations are ongoing to assess the potential of functional imaging and biomarkers as tools for risk stratification. The collective goal is to further refine current stratification strategies to allow for an individualized, risk-adapted treatment approach that minimizes long-term late effects without compromising high cure rates.
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Affiliation(s)
- Lauren S Maeda
- Department of Medicine (Oncology), Stanford University School of Medicine, Stanford, CA 94305, USA
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21
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Rathore B, Kadin ME. Hodgkin's lymphoma therapy: past, present, and future. Expert Opin Pharmacother 2011; 11:2891-906. [PMID: 21050034 DOI: 10.1517/14656566.2010.515979] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD The treatment of Hodgkin's lymphoma (HL) with the use of radiotherapy and systemic chemotherapy has been one of the success stories of modern oncology. HL therapy has been the paradigm for the systematic evaluation of different curative modalities, resulting in cure for the majority of patients. The current focus is on designing initial therapeutic strategies that retain efficacy and minimize long-term toxicity. Appropriate use of pathologic, clinical, biologic and radiologic prognostic factors in identification of aggressive HL is paramount in designing a successful therapeutic strategy. AREAS COVERED IN THIS REVIEW This review addresses the current and future use of prognostic tools, including PET scanning and other biomarkers, in identifying patients with aggressive HL, with reference to publications from the last two decades. The current standard approaches with the use of combined modality therapy and systemic chemotherapy as well as the promising role of future response-adapted strategies is reviewed. WHAT THE READER WILL GAIN The reader will obtain a comprehensive review of risk assessment strategies as well as current and investigational therapeutic approaches in the management of HL. TAKE HOME MESSAGE In HL, appropriate utilization of risk assessment strategies is required to maximize therapeutic outcomes while minimizing toxicity, especially long-term toxicity. Response-adapted therapy utilizing PET has the potential to profoundly improve the therapeutic landscape in HL.
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Affiliation(s)
- Bharti Rathore
- Department of Medicine, Roger Williams Medical Center, Providence Rhode Island 02908, USA
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22
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Advani RH, Hoppe RT, Maeda LS, Baer DM, Mason J, Rosenberg SA, Horning SJ. Stage I-IIA non-bulky Hodgkin's lymphoma. Is further distinction based on prognostic factors useful? The Stanford experience. Int J Radiat Oncol Biol Phys 2010; 81:1374-9. [PMID: 20934280 DOI: 10.1016/j.ijrobp.2010.07.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 07/13/2010] [Accepted: 07/14/2010] [Indexed: 11/16/2022]
Abstract
PURPOSE In the United States, early-stage Hodgkin's lymphoma (HL) is defined as asymptomatic stage I/II non-bulky disease. European groups stratify patients to more intense treatment by considering additional unfavorable factors, such as age, number of nodal sites, sedimentation rate, extranodal disease, and elements of the international prognostic score for advanced HL. We sought to determine the prognostic significance of these factors in patients with early-stage disease treated at Stanford University Medical Center. METHODS AND MATERIALS This study was a retrospective analysis of 101 patients treated with abbreviated Stanford V chemotherapy (8 weeks) and 30-Gy (n=84 patients) or 20-Gy (n=17 patients) radiotherapy to involved sites. Outcomes were assessed after applying European risk factors. RESULTS At a median follow-up of 8.5 years, freedom from progression (FFP) and overall survival (OS) rates were 94% and 97%, respectively. From 33% to 60% of our patients were unfavorable per European criteria (i.e., German Hodgkin Study Group [GHSG], n=55%; European Organization for Research and Treatment of Cancer, n=33%; and Groupe d'Etudes des Lymphomes de l'Adulte, n=61%). Differences in FFP rates between favorable and unfavorable patients were significant only for GHSG criteria (p=0.02) with there were no differences in OS rates for any criteria. Five of 6 patients who relapsed were successfully salvaged. CONCLUSIONS The majority of our patients deemed unfavorable had an excellent outcome despite undergoing a significantly abbreviated regimen. Application of factors used by the GHSG defined a less favorable subset for FFP but with no impact on OS. As therapy for early-stage disease moves to further reductions in therapy, these factors take on added importance in the interpretation of current trial results and design of future studies.
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Affiliation(s)
- Ranjana H Advani
- Department of Medicine, Division of Medical Oncology, Stanford University Medical Center, Stanford, California 94305, USA.
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