Immunotherapy for Hodgkin Lymphoma

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Topics include: Treatments

Are there Hodgkin lymphoma treatments on the horizon that can activate a patient’s immune system to fight cancer? A panel of Hodgkin lymphoma experts including Dr. Andrew Evens, from Rutgers Cancer Institute of New Jersey, and Dr. Joshua Brody, from Icahn School of Medicine at Mount Sinai, share research updates on targeted therapies, CAR T-cell therapy and checkpoint inhibitors in development as immunotherapies for Hodgkin lymphoma. Watch now to find out the latest treatment news.

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Andrew Schorr:           

So, we’re talking about the immune system. How can we activate your immune system to target the cancer we missed the first time? So, Andy, in other hematologic malignancies, we’ve been talking about CAR T-cell therapy—chimeric antigen receptor T-cell therapy.

For the people who didn’t—where the initial therapy that could be curative didn’t work out for them, is there testing going on in CAR Ts for Hodgkin, and could that offer some way to activate their immune system to fight the cancer?

Dr. Evens                 

The quick answer is yes, it has been. In fact, there was a presentation literally an hour ago that was just presented at the conference center looking at—so, it’s a different target. What’s been put forward so far FDA-approved are the CD19, which are on B cells, and so, that—Hodgkin lymphoma is a B cell lymphoma, but it’s an interesting thing of—and, by the way, we called this Hodgkin disease for over 150 years because we didn’t know until the 1990s it came from a B lymphocyte. We thought it could have been a virus or infection.

And, it’s interesting—it’s a B cell, but it almost intentionally down-regulates a lot of its B cell markers, so you don’t see it. It is a B cell marker, but what it does express is CD30. So, that is an antigen that’s typically on T cells…

Andrew Schorr:    

…and monoclonal antibodies.

Dr. Evens                 

Well, that brentuximab vedotin (Adcetris) that Dr. Brody alluded to earlier is an anti-ADC to CD30. Okay, so, that’s good for an antibody/drug conjugate, but for CAR T, it’s actually a little bit more complex because that CD30 that I just mentioned is on normal T cells, and so, there’s some interesting aspects that I think can be navigated of if you’re putting an antibody on that T cell and reinjecting it, the issues you’re concerned about—obviously, you’d hope it all goes to the Hodgkin’s, but there’s a chance it could go after itself. It’s called fratricide. You don’t want the CAR T to go after itself, and certainly, you don’t want the CAR T to go after normal cells and get T-cell aplasia.

So, those have been some theoretical concerns. I would say it’s a little farther behind—the B-cell methodology—but it’s definitely there, and I would say it’s early, but promising. 

Esther Schorr:       

So, these are not supposed to be a suicide mission.

Dr. Evens                 

You do not want it, yeah. You want it to go after the right cells. Hopefully, they’ll be able to work through that. I think so.

Andrew Schorr:    

So, this whole idea of immunotherapy—can we somehow stimulate your immune system to turn against the cancer without hurting the healthy cells, which we worry about with chemotherapy over many years—is it hitting healthy cells and causing side effects or DNA damage down the road? So, when I talk to so many people in cancer research, they say this is the name of the game if we can get there. 

Dr. Brody:               

This is the name of the game already for some cancers, and luckily, Hodgkin’s is the poster child of success for another immunotherapy. So, the CAR T cells have been a huge advance, mostly in non-Hodgkin’s lymphoma, and they’re just getting started in Hodgkin’s lymphoma, not as far ahead.

But, another type of immunotherapy—we give it a few names—we can call it “checkpoint blockade,” and this was the subject of the 2018 Nobel prize. This is what was awarded for teams that discovered one type of checkpoint blockade we call CTLA-4 blockade and another type we call PD-1 blockade. And, this PD-1 blockade—PD-1 is a brake pedal on our own immune cells, and that brake pedal stops those immune cells from killing cancer cells, so all we do is we cut the brake line.

We put an antibody that blocks that brake pedal. These are called anti-PD-1 antibodies, and these anti-PD-1 antibodies are the biggest story in all of oncology because they’re very effective in a number of cancers—melanoma, kidney cancer, lung cancer, bladder cancer, a few others—but they are more effective in Hodgkin’s lymphoma than any other cancer we’ve ever looked at.

Just to give you an example, in lung cancer—this is huge progress for lung cancer—they have 20 to 25 percent response rates, these anti-PD-1 antibodies. In Hodgkin’s lymphoma, 65 to 70 percent response rates, and these are for people for whom the standard chemotherapy and even the standard autologous transplant has been ineffective. So, this immunotherapy is a huge piece of progress.

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 September 9, 2019