Case suggests that nivolumab may be an effective treatment for refractory Burkitt lymphoma
Checkpoint inhibitor nivolumab may be an effective treatment for refractory Burkitt lymphoma, a rare and aggressive form of cancer. This is an important development for patients whose cancer cells remain resistant to usual treatment with high-dose chemotherapy. A case report is published in Annals of Internal Medicine.
Checkpoint inhibitors have been proven effective and are approved for treating Hodgkin lymphoma and primary mediastinal B-cell lymphoma. However, they have shown limited efficacy in common non-Hodgkin lymphoma subtypes and use in patients with Burkitt lymphoma has not been previously reported.
Researchers from the University of California, Los Angeles report the case of a patient with successful treatment of refractory Burkitt lymphoma using nivolumab. They started the patient on the prevailing standard-of-care chemotherapy to initial good results. However, a few days before cycle 2 of his chemotherapy, the patient's peripheral marker of cancer (LDH) started trending upward, likely indicating rapidly progressive disease. After repeating the course another time with the same results, the physicians discussed the options with the patient: more chemotherapy; the possibility of hospice; and the option of changing treatment to nivolumab. They made the shared decision to proceed with nivolumab, 480 mg every 4 weeks with additional standard medications. After initiation of nivolumab, the patient's LDH level decreased substantially to within the normal range, where it remained during the past 5 months. Six months after initial diagnosis, the patient had no symptoms, LDH remained undetectable, and his scans showed no evidence of disease after 4 months of nivolumab treatment.
Based on their experience with this patient, the researchers encourage clinical trials to establish the role of checkpoint inhibitors for treating Burkitt lymphoma, especially in patients who are refractory to current chemotherapy regimens.