New Immunotherapy Treatment Approved for Children and Adults with Hodgkin Lymphoma

On March 14, 2017, the Food and Drug Administration (FDA) approved pembrolizumab for the treatment of refractory Hodgkin lymphoma in children and adults who have been treated with at least three prior therapies.

Pembrolizumab is a type of immunotherapy called a checkpoint inhibitor. This drug consists of an antibody that binds to programmed death receptor-1 (PD-1), preventing the cancer cells from evading detection by the body’s immune system. Treatment with pembrolizumab allows T-cells (the fighter cells) to mount an immune response against the malignant cells.

Since 2014, Pembrolizumab has been FDA approved for the treatment of unresectable or metastatic melanoma, metastatic non-small-cell lung cancer, and recurrent or metastatic head and neck squamous cell carcinoma. The approval of pembrolizumab for the treatment of relapsed Hodgkin lymphoma was made under the FDA’s accelerated approval process.

This approval was based on data from a clinical trial of pembrolizumab in 210 adult patients with Hodgkin lymphoma who had relapsed or refractory disease after autologous stem cell transplant and/or treatment with brentuximab vedotin.  With a median follow up of 9.4 months, the overall response rate was 69%, including partial responses in 47% and complete responses in 22% of patients. The approval in pediatrics was based on known safety data and extrapolated efficacy based on the adult trial.

The most common adverse events in the trial were fatigue, fever, cough, musculoskeletal pain, diarrhea, and rash. Among 40 pediatric patients with advanced melanoma, PD-L1 positive tumors, or lymphoma, the side effects and overall safety profile was similar to adults.  A “warning and precaution” was added to the label describing the potential complications of graft-versus-host disease (GVHD) in patients undergoing allogeneic stem cell transplant after treatment with pembrolizumab.  Death related to GVHD has occurred and physicians are advised to monitor for hepatic veno-occlusive disease and grade 3-4 acute GVHD including hyperacute GVHD.

The recommended dose of pembrolizumab for patients with Hodgkin lymphoma is 200mg every 3 weeks in adults and 2mg/kg (up to 200mg) every 3 weeks in children.

At the Weill Cornell and NewYork-Presbyterian Lymphoma Program, we offer pembrolizumab as one of many treatment choices available for people with Hodgkin lymphoma.

Center for Lymphoma Announces the Formation of Adolescent and Young Adult Lymphoma Program

Lisa Roth, MD
Lisa Roth, MD

Recently the Center for Lymphoma announced the formation of the Adolescent and Young Adult (AYA) Lymphoma Program at Weill Cornell Medical College. The program is a collaborative effort between the Departments of Medicine and Pediatrics, and will be lead by Dr. Lisa Roth, a pediatric oncologist and new member of the Lymphoma Center.

Lymphoma is the most common malignancy in adolescents and young adults age 18-30y. While there has been remarkable progress in the treatment of children and older adults, improvements among adolescents and young adults have lagged behind. The reasons for this discrepancy are multifactorial, but include low enrollment in clinical trials, poor access to healthcare services, and a deficit in clinical and translational research in this area. The AYA Lymphoma Program seeks to advance the treatment of lymphoma in the AYA age group through the following missions:

1) Optimize medical care for AYA patients with lymphoma.

2) Provide psycho-social support tailored to AYA patients.

3) Lead clinical and translational studies aimed at improving outcomes in this age group.

Weill Cornell Medical College is in a unique position to treat AYA patients with lymphoma given the strengths of the Center for Lymphoma and the Division of Pediatric Oncology. Dr. Roth has been a Weill Cornell faculty member since joining the Department of Pediatrics in 2012. She is the Charles, Lillian, and Betty Neuwirth Clinical Scholar in Pediatric Hematology/Oncology and has been awarded fellowships from the Lymphoma Research Foundation and the Empire Clinical Research Investigator Program. Dr. Roth will work closely with a team of doctors, physician assistants, social workers, and researchers all with the common goal of improving outcomes for adolescents and young adults with lymphoma.

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