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Picardi M, Giordano C, Pugliese N, Esposito M, Fatigati M, Muriano F, Rascato MG, Pepa RD, D'Ambrosio A, Vigliar E, Troncone G, Russo D, Mascolo M, Esposito G, Prastaro M, Esposito R, Tocchetti CG, Fonti R, Mainolfi C, Del Vecchio S, Pane F. Liposomal doxorubicin supercharge-containing front-line treatment in patients with advanced-stage diffuse large B-cell lymphoma or classical Hodgkin lymphoma: Preliminary results of a single-centre phase II study. Br J Haematol 2022; 198:847-860. [PMID: 35819919 PMCID: PMC9541306 DOI: 10.1111/bjh.18348] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 11/28/2022]
Abstract
We evaluated the impact of liposomal doxorubicin (NPLD) supercharge-containing therapy on interim fluorodeoxyglucose positron emission tomography (interim-FDG-PET) responses in high-risk diffuse large B-cell lymphoma (DLBCL) or classical Hodgkin lymphoma (c-HL). In this phase II study (2016-2021), 81 adult patients with advanced-stage DLBCL (n = 53) and c-HL (n = 28) received front-line treatment with R-COMP-dose-intensified (DI) and MBVD-DI. R-COMP-DI consisted of 70 mg/m2 of NPLD plus standard rituximab, cyclophosphamide, vincristine and prednisone for three cycles (followed by three cycles with NPLD de-escalated at 50 mg/m2 ); MBVD-DI consisted of 35 mg/m2 of NPLD plus standard bleomycin, vinblastine and dacarbazine for two cycles (followed by four cycles with NPLD de-escalated at 25 mg/m2 ). Patients underwent R-COMP-DI and MBVD-DI with a median dose intensity of 91% and 94% respectively. At interim-FDG-PET, 72/81 patients (one failed to undergo interim-FDG-PET due to early death) had a Deauville score of ≤3. At end of treatment, 90% of patients reached complete responses. In all, 20 patients had Grade ≥3 adverse events, and four of them required hospitalisation. At a median 21-months of follow-up, the progression-free survival of the entire population was 77.3% (95% confidence interval 68%-88%). Our data suggest that the NPLD supercharge-driven strategy in high-risk DLBCL/c-HL may be a promising option to test in phase III trials, for improving negative interim-FDG-PET cases incidence.
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Affiliation(s)
- Marco Picardi
- Department of Clinical Medicine and SurgeryFederico II University Medical SchoolNaplesItaly
| | - Claudia Giordano
- Department of Clinical Medicine and SurgeryFederico II University Medical SchoolNaplesItaly
| | - Novella Pugliese
- Department of Clinical Medicine and SurgeryFederico II University Medical SchoolNaplesItaly
| | - Maria Esposito
- Department of Clinical Medicine and SurgeryFederico II University Medical SchoolNaplesItaly
| | - Melania Fatigati
- Department of Clinical Medicine and SurgeryFederico II University Medical SchoolNaplesItaly
| | - Francesco Muriano
- Department of Clinical Medicine and SurgeryFederico II University Medical SchoolNaplesItaly
| | - Maria G. Rascato
- Department of Clinical Medicine and SurgeryFederico II University Medical SchoolNaplesItaly
| | - Roberta Della Pepa
- Department of Clinical Medicine and SurgeryFederico II University Medical SchoolNaplesItaly
| | - Alessandro D'Ambrosio
- Department of Clinical Medicine and SurgeryFederico II University Medical SchoolNaplesItaly
| | - Elena Vigliar
- Department of Public HealthFederico II University Medical SchoolNaplesItaly
| | - Giancarlo Troncone
- Department of Public HealthFederico II University Medical SchoolNaplesItaly
| | - Daniela Russo
- Department of Advanced Biomedical SciencesFederico II University Medical SchoolNaplesItaly
| | - Massimo Mascolo
- Department of Advanced Biomedical SciencesFederico II University Medical SchoolNaplesItaly
| | - Giovanni Esposito
- Department of Advanced Biomedical SciencesFederico II University Medical SchoolNaplesItaly
| | - Mariella Prastaro
- Department of Advanced Biomedical SciencesFederico II University Medical SchoolNaplesItaly
| | - Roberta Esposito
- Department of Clinical Medicine and SurgeryFederico II University Medical SchoolNaplesItaly
| | - Carlo G. Tocchetti
- Departments of Translational Medical SciencesFederico II University Medical SchoolNaplesItaly
| | - Rosa Fonti
- Department of Advanced Biomedical SciencesFederico II University Medical SchoolNaplesItaly
| | - Ciro Mainolfi
- Department of Advanced Biomedical SciencesFederico II University Medical SchoolNaplesItaly
| | - Silvana Del Vecchio
- Department of Advanced Biomedical SciencesFederico II University Medical SchoolNaplesItaly
| | - Fabrizio Pane
- Department of Clinical Medicine and SurgeryFederico II University Medical SchoolNaplesItaly
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2
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Santoro A, Mazza R, Spina M, Califano C, Specchia G, Carella M, Consoli U, Palombi F, Musso M, Pulsoni A, Kovalchuk S, Bonfichi M, Ricci F, Fabbri A, Liberati AM, Rodari M, Giordano L, Chimienti E, Balzarotti M, Sorasio R, Gallamini A, Ghiggi C, Ciammella P, Ricardi U, Chauvie S, Carlo-Stella C, Merli F. Dose-dense ABVD as first-line therapy in early-stage unfavorable Hodgkin lymphoma: results of a prospective, multicenter double-step phase II study by Fondazione Italiana Linfomi. Ann Hematol 2021; 100:2547-2556. [PMID: 34327561 DOI: 10.1007/s00277-021-04604-x] [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: 02/04/2021] [Accepted: 07/04/2021] [Indexed: 11/28/2022]
Abstract
We investigated the feasibility and activity of an intensified dose-dense ABVD (dd-ABVD) regimen in patients with early-stage unfavorable Hodgkin lymphoma (HL). This prospective, multicenter, phase II study enrolled 96 patients with newly diagnosed, unfavorable stage I or II classical HL. The patients received four cycles of dd-ABVD followed by radiotherapy. Interim PET (PET-2) was mandatory after two courses. Primary endpoints were the evaluation of dd-ABVD feasibility and activity (incidence of PET-2 negativity). The feasibility endpoint was achieved with 48/52 (92.3%) patients receiving > 85% of the programmed dose. The mean dose intensity in the overall patient population (n = 96) was 93.7%, and the median duration of dd-ABVD was 85 days (range, 14-115) versus an expected duration of 84 days. PET-2 was available for 92/96 (95.8%) patients, of whom 79 were PET-2 negative (85.9%). In total, 90 (93.8%) patients showed complete response at the end of treatment. With a follow-up of 80.9 months (3.3-103.2), the median progression-free survival (PFS) and overall survival (OS) were not reached. At 84 months, PFS and OS rates were 88.4% and 95.7%, respectively. No evidence for a difference in PFS or OS was observed for PET-2-negative and PET-2-positive patients. Infections were documented in 8.3% and febrile neutropenia in 6.2% of cases. Four patients died: one had alveolitis at cycle 3, one death was unrelated to treatment, and two died from a secondary cancer. dd-ABVD is feasible and demonstrates activity in early-stage unfavorable HL. The predictive role of PET-2 positivity in early-stage unfavorable HL remains controversial. The study was registered in the EudraCT (reference number, 2011-003,191-36) and the ClinicalTrials.gov (reference number, NCT02247869) databases.
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Affiliation(s)
- Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Italy. .,IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Rita Mazza
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Michele Spina
- Medical Oncology Division, Centro Riferimento Oncologico, Aviano, Italy
| | - Catello Califano
- Onco-Hematology Department, A. Tortora Hospital, Pagani, Salerno, Italy
| | - Giorgina Specchia
- Emergency and Transplantation Department, Hematology Section, University of Bari Medical School, Bari, Italy
| | - Michele Carella
- Hematology and Bone Marrow Transplantation Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Clinica La Madonnina, Milan, Italy.,Clinica Villa Pia, Rome, Italy
| | - Ugo Consoli
- Hematology Department, Garibaldi Nesima Hospital, Catania, Italy
| | | | - Maurizio Musso
- Onco-Hematology Unit, Casa Di Cura "La Maddalena", Palermo, Italy
| | - Alessandro Pulsoni
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | | | - Francesca Ricci
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | | | - Anna Marina Liberati
- Onco-Hematology Division, S. Maria Hospital, Università Degli Studi Di Perugia, Terni, Italy
| | - Marcello Rodari
- IRCCS Humanitas Clinical and Research Hospital, Department of Diagnostic Imaging, Via Manzoni 56, Milano, Rozzano, Italy
| | - Laura Giordano
- Biostatistic Unit, Humanitas Clinical and Research Hospital, Rozzano, Milano, Italy
| | | | - Monica Balzarotti
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Roberto Sorasio
- Division of Hematology, S. Croce E Carle Hospital, Cuneo, Italy
| | - Andrea Gallamini
- Division of Hematology, S. Croce E Carle Hospital, Cuneo, Italy.,Research and Clinical Innovation Department, Centre Antoine-Lacassagne, Nice, France
| | - Chiara Ghiggi
- Hematology and Bone Marrow Transplantation Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Patrizia Ciammella
- Radiation Oncology Unit, Azienda Unità Sanitaria Locale IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Umberto Ricardi
- Oncology Department, Radiation Oncology, University of Torino, Torino, Italy
| | - Stephane Chauvie
- Medical Physics Department, S. Croce E Carle Hospital, Cuneo, Italy
| | - Carmelo Carlo-Stella
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Francesco Merli
- Hematology Department, Azienda Unità Sanitaria Locale IRCCS Di Reggio Emilia, Reggio Emilia, Italy
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Dalal M, Gupta J, Price K, Zomas A, Miao H, Ashaye A. Efficacy and safety of front-line treatments for advanced Hodgkin lymphoma: a systematic literature review. Expert Rev Hematol 2020; 13:907-922. [PMID: 32749937 DOI: 10.1080/17474086.2020.1793666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess evidence on the safety and efficacy of ABVD (doxorubicin [Adriamycin®], bleomycin, vinblastine, and dacarbazine), BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone), and A+AVD (brentuximab vedotin, with doxorubicin, vinblastine, and dacarbazine) for advanced-stage Hodgkin lymphoma (HL). METHODS A systematic literature review (SLR) was conducted on 29 July 2016 (updated 26 July 2018) to identify randomized controlled trials (RCTs) and non-RCTs assessing the treatment of newly-diagnosed advanced-stage HL with ABVD and BEACOPP (and their variants), and A+AVD. RESULTS The SLR identified 62 RCTs and 42 non-RCTs. Five-year overall survival rates for ABVD and BEACOPP were 60-97% and 84-99%, and 5-year progression-free survival rates were 58-81% and 83-96%, respectively. Both regimens were associated with tolerability issues and side effects. Discontinuation or dose reduction of bleomycin resulted in fewer adverse events, without significantly affecting efficacy. A head-to-head trial demonstrated improved efficacy for A+AVD vs ABVD, with an acceptable tolerability profile. No data from head-to-head trials comparing A+AVD with BEACOPP were available, and an indirect treatment comparison was not feasible. CONCLUSION New therapies, such as A+AVD, maintain the efficacy observed with current treatments, and may provide a more tolerable treatment option for patients with advanced-stage HL.
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Affiliation(s)
- Mehul Dalal
- Global Evidence & Outcomes - Oncology, Millennium Pharmaceuticals, Inc. a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , Cambridge, MA, USA
| | - Jatin Gupta
- Global Access, Decision Resources Group , Gurugram, Haryana, 122002, India
| | - Kim Price
- Global Access, Decision Resources Group, 6 Talisman Business Centre, Bicester , Oxfordshire, USA
| | - Athanasios Zomas
- Global Medical Affairs - Oncology, Millennium Pharmaceuticals, Inc. a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Harry Miao
- Clinical Sciences , Millennium Pharmaceuticals, Inc. a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Ajibade Ashaye
- Global Evidence & Outcomes - Oncology, Millennium Pharmaceuticals, Inc. a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , Cambridge, MA, USA
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Sureda A, Domingo-Domenech E, Gautam A. Neutropenia during frontline treatment of advanced Hodgkin lymphoma: Incidence, risk factors, and management. Crit Rev Oncol Hematol 2019; 138:1-5. [DOI: 10.1016/j.critrevonc.2019.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 01/15/2019] [Accepted: 03/26/2019] [Indexed: 10/27/2022] Open
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Melani C, Advani R, Roschewski M, Walters KM, Chen CC, Baratto L, Ahlman MA, Miljkovic MD, Steinberg SM, Lam J, Shovlin M, Dunleavy K, Pittaluga S, Jaffe ES, Wilson WH. End-of-treatment and serial PET imaging in primary mediastinal B-cell lymphoma following dose-adjusted EPOCH-R: a paradigm shift in clinical decision making. Haematologica 2018; 103:1337-1344. [PMID: 29748435 PMCID: PMC6068044 DOI: 10.3324/haematol.2018.192492] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/10/2018] [Indexed: 11/28/2022] Open
Abstract
Dose-adjusted-EPOCH-R obviates the need for radiotherapy in most patients with primary mediastinal B-cell lymphoma. End-of-treatment PET, however, does not accurately identify patients at risk of treatment failure, thereby confounding clinical decision making. To define the role of PET in primary mediastinal B-cell lymphoma following dose-adjusted-EPOCH-R, we extended enrollment and follow up on our published phase II trial and independent series. Ninety-three patients received dose-adjusted-EPOCH-R without radiotherapy. End-of-treatment PET was performed in 80 patients, of whom 57 received 144 serial scans. One nuclear medicine physician from each institution blindly reviewed all scans from their respective institution. End-of-treatment PET was negative (Deauville 1-3) in 55 (69%) patients with one treatment failure (8-year event-free and overall survival of 96.0% and 97.7%). Among 25 (31%) patients with a positive (Deauville 4-5) end-of-treatment PET, there were 5 (20%) treatment failures (8-year event-free and overall survival of 71.1% and 84.3%). Linear regression analysis of serial scans showed a significant decrease in SUVmax in positive end-of-treatment PET non-progressors compared to an increase in treatment failures. Among 6 treatment failures, the median end-of-treatment SUVmax was 15.4 (range, 1.9-21.3), and 4 achieved long-term remission with salvage therapy. Virtually all patients with a negative end-of-treatment PET following dose-adjusted-EPOCH-R achieved durable remissions and should not receive radiotherapy. Among patients with a positive end-of-treatment PET, only 5/25 (20%) had treatment-failure. Serial PET imaging distinguished end-of-treatment PET positive patients without treatment failure, thereby reducing unnecessary radiotherapy by 80%, and should be considered in all patients with an initial positive PET following dose-adjusted-EPOCH-R (clinicaltrials.gov identifier 00001337).
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Affiliation(s)
- Christopher Melani
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Mark Roschewski
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Clara C Chen
- Nuclear Medicine Division, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Lucia Baratto
- Nuclear Medicine and Molecular Imaging Division, Stanford University, CA
| | - Mark A Ahlman
- Nuclear Medicine Division, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Milos D Miljkovic
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jessica Lam
- Stanford Cancer Institute, Stanford University, CA
| | - Margaret Shovlin
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Stefania Pittaluga
- Laboratory of Pathology, Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Elaine S Jaffe
- Laboratory of Pathology, Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Wyndham H Wilson
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Abstract
There is now good evidence that the escalated BEACOPP regimen (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, prednisone) is more effective in controlling advanced-stage Hodgkin lymphoma (HL) than the widely used ABVD regimen (adriamycin, bleomycin, vinblastine, dacarbazine), but the extra efficacy comes at the expense of both short- and long-term toxicity, and there is debate as to whether overall survival is affected. Baseline prognostic factors have proven of limited utility for determining which patients require more intensive therapy and recent studies have sought to use interim fluoro-deoxyglucose positron emission tomography (FDG-PET) evaluation as a means to guide the modulation of treatment, both upwards and downwards in intensity. These suggest that if treatment starts with ABVD then patients remaining PET-positive after 2 months can be salvaged with escalated BEACOPP in around 65% of cases, but those becoming PET-negative may still experience recurrences in 15%-20%, an event that is more common in those with more advanced disease at presentation. There are early data to suggest that starting with escalated BEACOPP may reduce the rate of recurrence after a negative interim PET to less than 10%. This may be an attractive approach for those with very high-risk features at presentation, but risks overtreating many patients if applied nonselectively. New regimens incorporating antibody-drug conjugates may shift the balance of efficacy and toxicity once again, and further studies are underway to evaluate this.
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Affiliation(s)
- Theodoros P Vassilakopoulos
- Department of Haematology, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.
| | - Peter W M Johnson
- Cancer Research UK Centre, University of Southampton, Southampton General Hospital, Southampton, England
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Pinto A, Corazzelli G. Feasibility and efficacy of dose-dense and dose-intense ABVD for high-risk patients with advanced Hodgkin lymphoma: reply to D'Arco et al. Br J Haematol 2015; 171:665-8. [PMID: 25892204 DOI: 10.1111/bjh.13430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Antonello Pinto
- Haematology-Oncology and Stem Cell Transplantation Unit, Department of Haematology, National Cancer Institute, Fondazione 'G. Pascale', IRCCS, Naples, Italy. ,
| | - Gaetano Corazzelli
- Haematology-Oncology and Stem Cell Transplantation Unit, Department of Haematology, National Cancer Institute, Fondazione 'G. Pascale', IRCCS, Naples, Italy
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D'Arco AM, Califano C, Barone L, Belsito Petrizzi V, Iovino V, Langella M, Maglione V, Rivellini F, De Lorenzo S. Feasibility and efficacy of dose-dense and dose-intense ABVD for high-risk patients with advanced Hodgkin lymphoma. Br J Haematol 2015; 171:662-5. [PMID: 25873239 DOI: 10.1111/bjh.13429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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