Expert Updates in Hodgkin Lymphoma From ASH 2018 | Transcript | Hodgkin Lymphoma | Patient Power


Expert Updates in Hodgkin Lymphoma From ASH 2018

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.

Lee Swanson:

Hello. This is Lee Swanson for the American Society of Hematology conference in San Diego for Patient Power, and I'm joined today by Dr. Rad Ramchandren from Detroit, the Karmanos Cancer Institute. Hodgkin lymphoma is one of your specialties, and what are you hearing at this conference about that?  

Dr. Ramchandren:

You know, it's an exciting conference, because we got to hear a lot of different things and a lot of perspectives in Hodgkin's lymphoma.  Recently, over the past couple years, the thing that's really come to the forefront is combination therapy and immunotherapy for Hodgkin's lymphoma. And as we've become more and more sophisticated, for lack of a better word, in our management not only of side effects but how to use these very powerful tools I think we are getting a great deal of information and particularly so now in the Hodgkin's population.  

So I have just been to a session where we looked at incorporating a type of immunotherapy called CAR?T cell in Hodgkin's lymphoma, modifying the current antibodies that we have to increase responses and potentially minimize toxicities and combining either different types of immunotherapies together to see if we can get a better response as well as combining them with other therapies like brentuximab vedotin, which is an antibody drug conjugate which works differently than immune therapy but also is very active in this disease.  

Lee Swanson:

And so traditionally it was ABVD.  Are we moving away from that?  Where do we stand there?  

Dr. Ramchandren:

So ABVD has been around as long as I have, which is saying something.  The combination of ABVD in frontline therapy is very good in terms of activity combination regimen, but it certainly doesn't cure everyone, and there are patients, particularly those that would benefit from incorporating these new drugs to a regimen with a backbone that's similar to ABVD and may right now incorporate some of the ABVD drugs with them.   

So I think we are trying to improve on ABVD and the ECHELON?1 study was the first step in that which combined brentuximab vedotin with AVD.  There are other studies now looking at how to combine other novel agents with this backbone.  And ideally the hope is that at some point in the future we don't need chemotherapy to treat Hodgkin's at least initially.  We are a few steps away from that, but every study, every research endeavor that we pursue is in line with that goal.   

The other big thing in Hodgkin's lymphoma is that since ABVD does cure a sizable proportion of patients it is unfortunately also associated with side effects.  So can we use these new drugs to not only maybe cure more patients but also minimize side effects, and that's been a goal of ours as well.  

Lee Swanson:

Now, Hodgkin's not all that common, so if you go to a community doctor, there are these new developments, what does a patient or a parent talk to that doctor about to know that they're getting down the right path?  

Dr. Ramchandren:

Yeah, so I mean that's a great question.  There's roughly 9,000 new cases of Hodgkin's diagnosed annually in North America and the United States, so it's not something you may see every day if you don't do it for a living.  Even oncologists may only see one or two cases a year, so there are a lot of changes and particularly management of side effects.  You know, in the United States we have had the aim of trying to continue therapy on schedule about the appropriate doses, because there is a sense and data that suggest that doing that gives you your best chance of cure.  

Now with some of these regimens, for example with ABVD, the data suggests that we should not be using growth factor, however with—which is a stimulant to help your immune system and your white blood cell count.  On the other hand, when you use a different regimen called AAVD, which is brentuximab vedotin (Adcetris) AVD growth factor or blood simulation is highly recommended. So these are nuances that come with experience and practice.  Also looking at side effects such as lung toxicities, neuropathies, immune-related side effects from the immune changes that we get, these are all things that patients, caregivers and doctors should be comfortable and aware of going into the process of treatment with chemotherapy or immunotherapy, which is obviously a very difficult and confusing time for patients and their families. 

Lee Swanson:

Well, thank you for taking the time today.  We appreciate it very much.  

Dr. Ramchandren:

Thank you. It was my pleasure.  

Lee Swanson:

This is Lee Swanson with the American Society of Hematology, San Diego.  

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

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Page last updated on January 4, 2019