Cancer Treatment Today » Chemotherapy

Revlimid for Hodgkin’s

M Levin, MD — Thu, 04 Apr 2013 13:55:35 +0000

Although there is some evidence supporting (lenalidomide)Revlmid for non-Hodgkin’s Lymphoma, there is much less evidence for Hodgkin’s lymphoma. A recent phase II study in 38 patients with Hodgkin;s suggested that lenalidomide was well tolerated, and the most common grade serious toxicities were low white counts (47%), anemia (29%), and low platelets (18%). Four patients discontinued lenalidomide because of rash, elevated liver tests, and low blood counts. It concluded that the study provides preliminary evidence of lenalidomide’s activity in patients with relapsed and refractory non-Hodgkin’s lymphoma, and therefore exploration of lenalidomide in combination with other active agents is warranted. Several other small studies have come to similar conclusions. Several phase II studies are exploring activity of lenalidomide by itself or in combination.

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Afinitor for Hodgkin’s

M Levin, MD — Tue, 12 Mar 2013 03:28:02 +0000

Afinitor is a new drug that ahs effects on a pathway important in Hodgkin’s disease. A recent study showed soverall response of 47% (95% CI: 24-71%). Four responders remained progression free at 12 months. Several studies of combinations with everolimus for Hodgkin’s are lsited on clinicaltrials.gov. There is also the study: Study of RAD001 in Patients With Relapsed/Refractory Hodgkin Lymphoma That Has Progressed After High-dose Chemotherapy and Autologous Stem Cell Transplant and/or After Gemcitabine- or Vinorelbine- or Vinblastine- Based Treatment, NCT01022996.

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Zolinza for Hodgkin’s

M Levin, MD — Fri, 01 Mar 2013 21:03:38 +0000

Current chemotherapy drugs are very effective for Hodgkin’s lymphomas but patients who relapse after receiving them don;t do as well. This is because the cancers develop resistance to the se drugs. Zolinza is a new drug approved in the USA for the treatment of cutaneous(skin) T-cell lymphoma who have progressive, persistent or recurrent disease or following two systemic therapies. It may be effective for Hodgkin’s. For Hodgkin’s, a phase II study enrolled twenty-five eligible patients. The overall resposne rate was low, 4% (one partial response), but the drug was well tolerated. A phase I clinical trial treated several types of lymphoma. The best responses were seen in those with Hodgkin and diffuse large B-cell lymphoma (Budde et al). A study of Vorinostat and Lenalidomide in Treating Patients With Relapsed or Refractory Hodgkin Lymphoma or Non-Hodgkin Lymphoma was started at the City of Hope but was terminated.

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GDP for Hodgkin’s salvage chemotherapy

M Levin, MD — Wed, 13 Feb 2013 20:04:07 +0000

Relapsed or refractory Hodgkin lymphoma, disease that does not respond to chemotherapy or comes back after chemo, is a challenging problem for clinicians who treat hematologic malignancies. The general approach involves salvage chemo and a consideration of stem cell transplantation, if salvage succeeds. Unfortunately, there is not consesnsus as to what salvage combiantions of drugs should be used, becasue there are very few comparisons of different salvage combinations. Many of the published randomized controlled trials of autologous stem cell transplantation used mini-BEAM or dexa-BEAM, so some experts think that these regimens should be considered standard regimens in this settin. Gemzar/cisplatin/dexamethasone in patients with relapsed Hodgkin’s lymphoma was published in 2003 by Baez et a. The trial included 23 patients and overall response rate was nearly 70%; the remaining 30% of patients achieved disease stabilization. No patient experienced progressive disease while being treated with Gemzar/cisplatin/dexamethasone. Toxicity was mild and all patients were able to undergo a subsequent autologous stem cell transplant. NCCN is more liberal and lists GDP (gemcitabine, carboplatin and dexamethasone)as well as other regimesn based solely on phase II studies.

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Rituxan and Rituxan with Gemcitabine for Hodgkin’s Disease

M Levin, MD — Thu, 09 Aug 2012 17:56:42 +0000

Until recently rituximab, or Rituxan has been thought of as a drug for Non-Hodgkin’s lymphoma. Rituxan® is a monoclonal antibody approved for treatment of non-Hodgkin’s lymphoma (NHL) and binds to a lymphoma surface molecule called CD 20. A small subset of patients with Hodgkin’s lymphoma (3% to 8%) has a type of cancer called CD 20 lymphocyte predominant Hodgkin’s lymphoma, characterized by a large proportion of their cancer cells expressing CD 20. Patients with CD 20 lymphocyte predominant Hodgkin’s lymphoma tend to have a higher rate of recurrence following standard therapy against Hodgkin’s lymphoma than other patients with Hodgkin’s lymphoma. According to results recently published in the journal Blood, Rituxan® (rituximab) appears to be a promising agent in the treatment of some patients with recurrent Hodgkin’s.

NCCN on p. HODG-E says that Rituxan should be considered for all patients with relapsed Hodgkin’s disease. It recommends it with ABVD for Lymphocyte Predominant Hodgkin’s in first line. It does not address other combination chemotherapy with Rituxan.

Gemcitabine has been combined with Rituxin and with rituximab and other drugs in studies for relapsed Hodgkin’s. These two drugs together in several phase II studies appear to be “mildly” active and well tolerated.

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