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2017 ; 22
(5
): 585-591
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FDA Approval Summary: Nivolumab for the Treatment of Relapsed or Progressive
Classical Hodgkin Lymphoma
#MMPMID28438889
Kasamon YL
; de Claro RA
; Wang Y
; Shen YL
; Farrell AT
; Pazdur R
Oncologist
2017[May]; 22
(5
): 585-591
PMID28438889
show ga
On May 17, 2016, after an expedited priority review, the U.S. Food and Drug
Administration granted accelerated approval to nivolumab for the treatment of
patients with classical Hodgkin lymphoma (cHL) that has relapsed or progressed
after autologous hematopoietic stem cell transplantation (HSCT) and
post-transplantation brentuximab vedotin (BV). Nivolumab in cHL had been granted
breakthrough therapy designation. Accelerated approval was based on two
single-arm, multicenter trials in adults with cHL. In 95 patients with relapsed
or progressive cHL after autologous HSCT and post-transplantation BV, nivolumab,
dosed at 3 mg/kg intravenously every 2 weeks, produced a 65% (95% confidence
interval: 55%-75%) objective response rate (58% partial remission, 7% complete
remission). The estimated median duration of response was 8.7 months, with
4.6-month median follow-up for response duration. The median time to response was
2.1 (range: 0.7-5.7) months. Among 263 patients with cHL treated with nivolumab,
21% reported serious adverse reactions (ARs). The most common all-grade ARs
(reported in ?20%) were fatigue, upper respiratory tract infection, cough,
pyrexia, diarrhea, elevated transaminases, and cytopenias. Infusion-related
reaction and hypothyroidism or thyroiditis occurred in >10% of patients; other
immune-mediated ARs, occurring in 1%-5%, included rash, pneumonitis, hepatitis,
hyperthyroidism, and colitis. A new Warning and Precaution was issued for
complications of allogeneic HSCT after nivolumab, including severe or hyperacute
graft-versus-host disease, other immune-mediated ARs, and transplant-related
mortality. Continued approval for the cHL indication may be contingent upon
verification of clinical benefit in a randomized trial. The Oncologist
2017;22:585-591 IMPLICATIONS FOR PRACTICE: Based on response rate and duration in
single-arm studies, nivolumab is a new treatment option for patients with
classical Hodgkin lymphoma (cHL) that has relapsed or progressed despite
autologous hematopoietic stem cell transplantation (HSCT) and brentuximab
vedotin. This was the first U.S. Food and Drug Administration marketing
application for a programmed cell death 1 inhibitor in hematologic malignancies.
The use of immune checkpoint blockade in cHL represents a new treatment paradigm.
The safety of allogeneic HSCT after nivolumab requires further evaluation, as
does the safety of nivolumab after allogeneic HSCT.
|*Drug Approval
[MESH]
|Antibodies, Monoclonal/adverse effects/*therapeutic use
[MESH]
|Brentuximab Vedotin
[MESH]
|Combined Modality Therapy
[MESH]
|Drug-Related Side Effects and Adverse Reactions/pathology
[MESH]
|Female
[MESH]
|Graft vs Host Disease/chemically induced/pathology
[MESH]