New drug dramatically improves survival in Hodgkin lymphoma patients
A new cancer drug with remarkably few side effects is dramatically improving survival in Hodgkin lymphoma patients who fail other treatments and are nearly out of options.
Loyola University Medical Center oncologist Scott E. Smith, MD, PhD presented survival data for the drug, brentuximab vedotin (Adcetris), at the 17th Congress of the European Hematology Association. Smith is director of Loyola's Hematological Malignancies Research Program.
The multi-center study included 102 Hodgkin lymphoma patients who had relapsed after stem cell transplants. Tumors disappeared in 32 percent of patients and shrank by at least half in 40 percent of patients. An additional 21 percent of patients experienced some tumor shrinkage. Only 6 percent of patients had no response to the drug.
Sixty five percent of patients were alive at 24 months, and in 25 percent of patients, the cancer had not progressed at all.
These are "encouraging results in patients with historically poor prognosis," researchers said.
Loyola patient Michelle Salerno had failed two stem cell transplants -- one using her own cells and one using cells donated by her brother -- and multiple rounds of chemotherapy before going on brentuximab vedotin. After three or four infusions, she stopped suffering chills, sweats, high fevers and itchy pain from head to toe. And she experienced almost none of the side effects common to chemotherapy.
"I kept my hair, and never felt like vomiting," she said. "You get the drug, you go home, you feel good."
The standard regimen is a 30-minute infusion every three weeks. A patient typically receives 16 doses over 48 weeks.
Loyola has administered about 500 doses to 60 patients. "A lot of our patients are doing great on this regimen," Smith said.
Hodgkin lymphoma is a cancer of the immune system. Most patients can be cured with chemotherapy or radiation, especially when the disease is diagnosed in early stages. However, if initial treatment fails, the patient may require an autologous stem cell transplant. This procedure uses the patient's own stem cells to replace immune system cells that are destroyed by high-dose chemotherapy or radiation.
About 50 percent of patients who undergo autologus stem cell transplants relapse. Among patients who relapse, only 10 percent survive.
The Food and Drug Administration last year approved brentuximab vedotin for patients who have either failed an autologous stem cell transplant, are ineligible for a stem cell transplant or have failed two multi-drug chemotherapy regimens.
Brentuximab vedotin is an antibody attached to a powerful chemotherapy drug. The antibody acts like a homing signal, bringing the chemo drug to lymphoma cells. "Brentuximab represents a very interesting new concept in the fight against cancer," said oncologist Tulio Rodriguez, MD, who treats Salerno and is medical director of Loyola's Bone Marrow Transplantation Program. "It delivers powerful chemotherapy right where it needs to be -- into the cancer cell."
Cancer patients frequently are debilitated not only by their cancer, but also by chemotherapy treatments. Targeted drugs such as brentuximab can spare patients from the harmful effects of traditional chemotherapy, Rodriguez said.
The study found that side effects from brentuximab were generally mild. Only 9 percent of patients suffered severe peripheral neuropathy, 2 percent had extreme fatigue and 1 percent had severe diarrhea.
Salerno said the only significant side effect she experienced was mild neuropathy, which went away when the dose was lowered.
Salerno, 43, has been battling Hodgkin lymphoma for 10 years. Although she is not cured, she said, "I feel great and have a good quality of life."
Salerno, who lives in Lombard, said her treatments inspired her to start a business. She markets the Joey Pouch -- a small, soft pouch designed to comfortably hold the lumens of a central venous catheter so a patient can be more comfortable in daily activities or while sleeping. It is worn around the neck, next to the chest. The Joey Pouch is named after Salerno's brother, Joey, who donated stem cells used in one of her transplants.
Rodriguez said he feels immense satisfaction when he goes over CT scans with Salerno to show her how her disease is heading back into remission. But he cautioned that brentuximab, like all drugs, has potential toxicities. "Patients should talk with their doctors about the pros and cons of taking this drug and discuss whether it is best for them," Rodriguez said.